By Arthur Lightbourn
If you see a doctor in green surgical scrubs walking around Scripps Memorial Hospital La Jolla with notes pen-written on his right pant leg, chances are you're seeing the hospital's newly elected chief of staff, Dr. Marc Sedwitz.
He jots notes on his pants because, as he puts it, "You can lose your Blackberry, but you won't lose your pants."
As you might guess, the stocky 57-year-old vascular and trauma surgeon is both busy and practical.
We interviewed him in the Schaetzel Center medical library on the campus of Scripps La Jolla 10 days before he assumed his new responsibilities on the threshold of a new era in health care in America.
Asked what would be his responsibilities as chief of a 900-member medical staff as of Jan. 1 for a two-year term, he said they will coincide with those of the medical executive committee, which are the credentialing of new physicians and conducting the peer review process.
However, "with health care reform being in its nascent state," he said, "the medical staff is going to be responsible for a lot more of the issues of physician behavior, patient safety and the ability for the hospital to acclimate to new crises in health care."
For 25 years, Scripps La Jolla has been North County's prime acute care emergency hospital as one of a network of six trauma centers serving San Diego County.
"As these changes occur in medicine," Sedwitz predicted, "this hospital will probably have more and more responsibilities and with that the chief of staff is going to be dedicated toward maintaining the physician excellence and patient safety.
"What we're going to see is a sudden change in how medicine is delivered. We are much more accountable in terms of what are called quality parameters, how we distinguish ourselves from a good hospital to an excellent hospital — what we're graded on.
"Physicians have always been very, very good at being graded. They got 98s in high school, in college and medical school, but medicine now is expecting 100 percent. And what we live with is trying to minimize that 2 percent of complications, the 2 percent of people with extended length of stays, maintaining our excellence in a time when we are going to see certainly a change in what economic reimbursement is going to be for this.
"You can't take 47 million people and make them have insurance at a time when hospitals are full and not have an impact on how your hospital is run and how physician responsibilities are met," he cautions.
The solution, he believes, will rest with educating physicians and utilizing new technologies, including information technologies in how physicians get information from labs and X-rays and how they communicate their thoughts to other physicians.
Also, advances in technology will improve how hospitals will view and analyze data revealing whether or not they are doing a good job in terms of "bundled" services between hospitals and their physicians to ensure the fair, equitable and collaborative distribution of reimbursements.
"Doctors will always do what they do best which is to care for people," he said. "The only question is how do we manage costs and who is going to determine what the rules are for doing it.
"Some of the medicines we give for cancer, for instance, cost thousands and thousands of dollars for a six-month increase in life expectancy. We still measure successful health by how long we live rather than quality of life. We have the conflict of our spiritual, emotional and definition of quality of life, with measuring it in number of years. That's why at the end of life it's so expensive in health care.
"Do we deprive someone at the age of 80 or 90 an important operation for their heart or their brain or their back to improve the quality of their life knowing that their life expectancy is limited?"
Those are the type of ethical and social questions that we are going to have to address as a society, he said.