Thursday, May 21, 2009

Medical Perfection by Dr. Ben Brown

At the end of last year, then president-elect Barack Obama’s health care transition team asked citizens to organize Health Care Community Discussions. Their purpose? To gather ideas from Americans across all walks of life about how our health care system could be reformed. Having been a rural family doctor for over 25 years I think such discussion is urgently needed. Each day I see my patients struggle to pay medical bills. I also see the losses they suffer when they cannot.

Eighteen people with a variety of experiences and interests came together in our community health care center in Nelson County, VA. to work through the Obama transition team’s agenda.

We first focused on the need for elimination of the greed motive in medicine. It seemed fair to us, that the profit motive should be limited when applied to the relief of human suffering. We recognized universal health care coverage as a right, much as education is considered a right. We also saw a public health campaign to improve diet, physical activity and living attitudes as key to reducing health care costs. I was surprised and pleased to hear broad support for a single payer system.

As I left the meeting, I felt there was still a difficult issue which we had not touched: the question of overuse in health care. There is an unrecognized trend in modern medicine which occurs at the nexus of media, doctors, courts and patients and leads to a significant and growing waste of health care dollars.
Of course, doctors want to give the best possible care, and also worry about being sued for neglecting to run more tests and procedures, many of which are expensive and make little difference. Patients want to believe they are getting the latest in health care, and are heavily influenced by the popular media. The media feels it is doing a public service by reporting about medical advancements and the newest drugs.

We, as patients, now expect a lab or radiology study in order to make medical decisions once made on the basis of clinical judgment. Whereas once we relied on a primary care doctor to reassure us, we now want a specialist to answer the questions raised by friends or from what we read online. And finally, malpractice juries understand one person's loss more easily than the statistics of evidenced-based medicine.

This all leads to patients receiving excessive, inappropriate and overly expensive medical care.

When do we reach the point of diminishing returns? What about treatment plans that lead to very little improvement in health care despite their excessive cost? Could those extra health care dollars, save and improve more lives if used differently?
In the real world, dollars spent on one person's quest for medical perfection cannot be spent on another's basic needs, and dollars spent in extending the last few days of life cannot be spent on helping others have healthier and more productive lives. These trade-offs matter.

Yes, let’s take care of the greed motive, simplify our system and give everyone a basic health care plan. But there is a component that the media, the malpractice system, the doctors and the people as patients have to face up to as well: When we demand too much for our single self, it means less for others.

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