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What were the chief factors involved in this
shift from the doctors being in charge of the
relationship to the community moving into
the “power position”? As individuals started
to pay more for their own health care, they
started to be a little more assertive about,
“Why am I paying for this?” and “’ Why don’t
I understand that bill?” and “Why are you
charging me $20 for an aspirin?” So I think
it’s come together to create an environment
where there’s a lot more accountability, which
I think is very healthy for the industry.
How harmful or helpful has the Internet
been in terms of informing or misinforming
patients — information that they then relay
to their doctors? It’s made the interaction
between the patients and physicians a little
more complex. On the other hand, I almost
always have to side in favor of the argument
that people being more informed is a good
thing. It’s actually, in its own way, improved
accountability, so when that patient shows up
with that WebMD article it does require the
physician to have at least read and thought
through the article and be able to discuss this
with the patient.
You’ve been in the University of California
system for 30 years. How does that health
care system operate compared to the private
sector? First is the deep intellectual challenge. When you work in a teaching hospital,
it’s characterized by having a lot of really
smart learners around, asking the physicians,
“Why are we doing this?” or “What about this
research?” or “What about that approach?”
It adds a level of intellectual rigor about how
health care is delivered. It’s just a privilege to
be part of something this important.
Besides the intellectual rigor you talk about,
how else does a teaching hospital vary from
a private facility? There are a lot more physicians around 24/7 because we have trainees,
residents, fellows — all different levels of training there, participating in the care of patients.
UCSF has done more kidney transplants than
any center in the world. It’s one of the original
centers of excellence in women’s health and in
end-of-life care. There’s a huge cancer center,
so it tends to be at the forefront of health care