For Assistant Surgeon General Douglas Kamerow, M.D., family medicine has always been about ...
The Big Picture
Douglas Kamerow, M.D., was finishing his family practice residency when he realized it took more than individual physicians to save the world.
"I went into family practice because I thought I could make a difference to individual patients. I thought that's what medicine was all about," said Kamerow, now an assistant surgeon general in the U.S. Public Health Service. "But during my residency, I realized that a lot of things in the small picture couldn't get fixed unless the big picture was fixed."
Douglas Kamerow, M.D., talks with a presidential subcommittee about technology assessment.
(Photo by Leigh Anne Bathke/AAFP)As a National Health Service Corps assignee in a family practice residency, Kamerow saw patients in an underserved area of Rochester, N.Y., with problems his skills couldn't cure.
"If their problems were socioeconomic, I found I couldn't help much," he said. "For some it came down to buying food or buying medicine. Some could not afford preventive medical treatment. That's when I decided to earn a master's degree in public health. I hoped that if I got involved with fixing things in the big picture, then it might help family physicians have more impact in the lives of individual patients."
Kamerow, now 47, has spent his career juggling research, policy development and clinical practice. He works to change the big picture in one career, while simultaneously working to help individual patients.
Kamerow has directed the new Center for Practice and Technology Assessment in the Public Health Service's Agency for Health Care Policy and Research since October 1997. The center was created last fall by merging two existing centers -- the Office of the Forum for Quality and Effectiveness in Health Care and the Center for Health Care Technology. The new center works to improve the quality of health care in the United States through the development and implementation of evidence-based tools, such as AHCPR's 19 clinical practice guidelines.
Kamerow, who was born in Washington, D.C., and still lives and works there, testified about technology assessment to a subcommittee of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry in December.
Kamerow stressed to the committee that the definition of technology needs to include all products and treatments used in health care, not just the expensive machines. And technology assessment also should include all existing technologies, not just the latest advances.
"Technology assessment plays a key role in quality of care considerations, as it helps to ensure the right service is delivered to the right person at the right time," testified Kamerow. "The field of technology assessment is a vibrant, active area with multiple public and private sector participants. Much duplication exists, however, and the quality of reports varies widely. Better coordination, with enhanced public-private partnerships, could yield large benefits."
AHCPR plans for the new Center for Practice and Technology Assessment to incorporate four elements:
- Twelve evidence-based practice centers already produce evidence reports and technology assessments -- the "front end" work of establishing guidelines. These centers do structured medical literature reviews rating the quality of literature on various subjects.
- The U.S. Preventive Services Task Force will reconvene this year to evaluate preventive care and update the Guide to Clinical Preventive Services.
- A national guideline clearinghouse -- a partnership of the AMA, the American Association of Health Plans and AHCPR -- will make health care guidelines available via the Internet.
- A research program complements every aspect of the center. "AHCPR sponsors health services research to improve the delivery of health care," said Kamerow. "Our center focuses on finding better ways to take evidence-based recommendations and move them into care."
On Thursday afternoons, Kamerow chucks his Public Health Service uniform and sees patients while working with family practice residents. He's a clinical professor in the family medicine department at Georgetown University.
"I've got quite a good career," said Kamerow. "I help develop policy and guidelines for physicians, and I still work with residents and patients. I can see how policy can help or hurt our patients."
By Leigh Anne Bathke, Associate Editor
FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.
