Inconvenient truth

[摘要] I thank Dr Warren Bell for his letter to the editor inthe January issue of Canadian Family Physician.1 I amso relieved and grateful to see this inconvenient truthaddressed.The other missing piece of payment model reform isthe simplified measurables approach to our top-downsilos of accountability; within these, the quantification of assumptions about patients seen and problems“addressed” are just as flawed as the ”quality” of caremeasurables apparently assured with guidelines andchronic disease or complex care tick boxes. There is nothing more complex than nature, including humannature and living systems. Unexamined and unknowncomponents affect the therapeutic relationship, theunderstanding of the unique nature of each problemand carrier thereof, and the outcome; examples of thesecomponents include nonverbal signals, adverse childhood experiences, whether the patient feels heard, anddisappointment with misunderstood science and withauthority or change. Without the time and patience tobuild this kind of relationship the tick boxes are aboutappearances and run contrary to free-market incentives.

[学科分类] 卫生学