Who Should Be In Charge Of Fixing Health Care?

I consider myself to be pretty handy with most household repairs.  In fact, I actually remodeled a kitchen in one of my early homes by myself, a bathroom in another and built a mahogany wet bar in my current one.  But when it came done to the detail work, I called an expert.  For the kitchen remodel, I called an electrician to rewire my circuit breaker box, run the additional wiring for the new lighting and upgraded cook top. I also had someone come out and measure, cut and install the counter top.  I knew better and wanted the finished product to not only look fantastic, but functional too.  The wet bar is a beautiful raised panel design.  I did all of the rough carpentry and paneling.   But when it came time for the crown molding, I called a professional.  It looks fantastic.  I appreciate anyone who knows their limitations and knows when to call a professional to supplement their work or complete an important project.  As a physician, I have no problem telling my patients that I don’t know, but I follow that up with “I’ll find out for you”.   And I do.  I could never imagine myself going to Washington, sitting in on a Congressional meeting and then commence to tell them, not only what they are doing wrong, but telling them how to fix all their problems that I just described for them.  But this is exactly what THEY are doing with health care. Who are they to tell such a large percentage of our GDP what to do?  What expertise, or day to day experience, do they have to tell anyone in health care what is wrong or what needs to be done in order to fix it?  None.

One comment that Mr. Obama made in his speech the other day was that the reforms he wanted to put into place would decrease medical errors and increase quality and one way of measuring this quality was by monitoring the re-admissions of patients. I’m afraid that is NOT a measure of quality in my experience, but a measure of the severity of a patient’s illness, a measure of the number of associated medical diagnoses and a measure of patient compliance.

For example: A 65 year old white female admitted with shortness of breath is found to have congestive heart failure. She is treated appropriately with diuretics, angiotensin converting enzyme inhibitors, nitrates and beta blockers.  She has an echocardiogram to measure the heart’s ability to pump blood.  The hospital and doctors order all of these in order to comply with Medicare’s “core measures” of quality (yes, they watch each case that closely). She is discharged after 5 days in the hospital feeling much better.  She goes home and the next morning slips on some spilt tea, and falls to the ground.  She is readmitted to the hospital with a hip fracture.  Is this an issue of quality?

A 74 year old black male with a 50 year history of tobacco abuse, oxygen dependent emphysema, heart disease and high cholesterol.  He is admitted with an exacerbation of his emphysema.  He receives steroids, hand held nebulizer treatments and antibiotics.  He improves slowly and is discharged home.  He refuses his pneumonia and flu vaccines. He is counseled on smoking cessation.  Once home he resumes smoking, catches a cold from his grandson and is readmitted.  He is intubated and placed on a ventilator in the intensive care unit. Is this an issue of quality?

A 67 year old white male with cirrhosis of the liver from life log alcohol abuse, repeated bouts of pancreatitis, chronic anemia, ascites and thrombocytopenia (low platelets) is admitted with an upper gastrointestinal bleed secondary to esophageal varices.  He undergoes endoscopy with sclerotherapy to stop the bleeding, a blood transfusion and medicine for alcohol withdrawal. He is referred to the transplant service for possible liver transplant but is rejected again, because of his ongoing alcohol abuse.  He is discharged home but continues to drink daily.  He is readmitted for an episode of bacterial peritonitis (infection involving the ascitic fluid in the abdomen).  Is this an issue of quality?

None of those scenarios are issues of quality by anyone’s standards except for Medicare. What is truly lacking is common sense.  Just like the restriction on the use of restraints. Patients who are demented and confused, and used to be restrained for their safety, are now denied that safety by Medicare guidelines and allowed to walk, fall down and break a hip.

Why should common sense ever be included in decision making?  I would propose that for every member of Congress, Legislator and member of the Executive Branch who is debating or contemplating health care reform, should have a partner who has practical, hands on experience in the trenches, where patients are actually cared for. What is really needed is practical, common sense, comprehensive reform but with the guidance of experts so the final product will be one we can all be proud of.

Gotta know when to call the carpenter.

Doc B.

My opinion is free.

Advice is worth exactly what you pay for it.


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