I was reading the opinion column in todays NJ Star Ledger regarding an article written by Stella Fitzgibbons MD, who is a hospital based board certified doctor in the Houston Area (http://articles.latimes.com/2010/jun/17/opinion/la-oe-fitzgibbons-health-costs-20100617). She talks about her experiences and who health cost containment is difficult leading to unnecessary testing. Apparently, many families pressure doctors to run many tests to rule out rare problems which the doctors experience had shown will respond well without the increase testing and intervention. She mentions other sources such as web sites and magazines which tell the patient to literally bully the doctor into doing certain procedures and tests.
From the health care providers perspective, what she has said is true from her unique perspective, however, people make many health decisions based on emotions and fear. Fear is a great motivator and our healthcare system has used and in some cases abused this to push patients into doing things they may never have done to themselves, sometimes with horrible and disfiguring effects. People have also been talked into taking harmful substances they would never have taken with horrible side effects because of the false hope they saw on television or the education their doctor received from the local drug rep convincing the doctor that this medication was indeed good for their patient.
When people come to the hospital with symptoms they do not understand, fear is ever present and rational thinking often is scarce, especially around caring family members who found their distressed family member. Our broken healthcare paradigm has literally brainwashed the american public to expect all these tests to leave no stone unturned even though a good exam and responsible recommendations are enough to stay within community standards of their medical specialty, which would protect them from malpractice lawsuits. .
There are not clear protocol recommendations for patients who enter the ER which eliminate the unnecessary use of diagnostic technologies giving families and the one who is ill a greater sense of confidence with the healthcare provider. The system is actually set up for people to want more because of the perception that more is better and the legal perception if liability if every last thing should be tested, even though in many cultures, it is not and people are in many instances are better off. A better system that would save costs, suffering and over testing would be one that would force the doctor to do certain protocols first. Then the patient has to wait a few days after following their home recommendations before further tests are done as they follow up with their own doctors. This would make sense and eliminate some unnecessary testing but not all. I doubt that would happen though because some lobbyist would likely call this rationing, some attorney would call it malpractice (which they cannot if the doctor follows community guidelines which is the way the average doctor in that specialty would behave) and would get the public in an uproar by using the appropriate buzz words.
Is it rational to steer patients down the most logical path based on the current science we have available? I believe it is and our healthcare systems can certainly help patients better with more rational and concise recommendations that take the patient and their families emotions out of the decisions.
In another case she mentions, she has a patient who just came into the IC unit after a huge stroke. She mentions that the family wants everything done to save the life of someone who is also in kidney failure and also has pneumonia. Again, failure of having concise protocols has the family making emotional demands that will prolong his suffering, are likely to fail on an individual with insufferable brain damage. The outcome with or without tubes and procedures is the same – the loss of a loved one. Our healthcare system needs to be able to council a family on the right thing to do which is prepare the patient and their family for the inevitable, rather than having these stressed and scared people make a decision they are likely unqualified to make in the situation that presents itself. The loss of a loved one is awful, and we do not want to let go. If the outcome is the same, and comfort rather than intervention is more humane, yields the same results and does not totally drain the persons bank account as well, shouldn’t the best course of treatment be a protocol that leads the family down the right path, rather than giving them the right to push for intervention which clearly is wrong.
Some may say that this takes away freedom of choice and is rationing. I call it rational health care policy. As many studies are finding out, often less is more which is especially true in healthcare. Many developed countries do more with less and the care is often excellent. Their understanding on life, death and taking care of oneself is healthier as well (our country is #38 in the WHO for health care quality). Yes, we americans can learn from other countries healthcare systems and we should.
In life, we are born, we live our lives and at a certain time, our bodies will fail, while we used our lives to procreate and create our legacies. Disney called this the great circle of life. Disney had it right, perhaps our medical systems should learn from Disney. Its as simple as that!
What do you think. I value your opinions.