“The parting of the art”
I would like to augment the excellent article “ Ouch says the wallet” by Katie Vane in last week’s Sheet. First and foremost, thank you to Katie and the Sheet for approaching the highly complex and constantly evolving subject of modern American medical care. This is a subject which touches all of our lives and is becoming more complicated with each passing day. As we come closer to advent of The Patient Protection and Affordable Care Act, commonly known as “Obamacare”, the practice of medicine will become even more complex than it already is.
Although I was quoted in last week’s article, I don’t claim to be an expert (at this point nobody can make that claim). The opinions I expressed are just that, well educated opinions. As a former physician and current patient advocate, I have experienced more than my share of the complexities of the current health care system. As I said last week, our system is spending vast quantities of money for very substandard results. The sad fact is that the art of medicine is circling the drain. Medical education for physicians and nurses places a great emphasis on critical thinking skills and intuition. There is little room for that presently as insurance companies and computers dictate the tenants of everyday patient care to providers. Unfortunately, compensation and litigation prevention are now paramount in medicine. If it were up to the fine folks in the trenches (doctors and nurses), this would not be the case. At this point, however, our hands are tied. Hospitals are forced to inflate the costs of their services as they are often compensated only a fraction of what they charge. Medical providers are caught in an ever-deepening quagmire of computer protocols and draconian state and federal regulations. It should be noted that guidelines and protocols have a valuable place as long as there are “escape hatches” for some patients who are outliers and don’t fit into predetermined slots. It is fairly clear, for example, that diabetes management guidelines improve outcomes for diabetic patients (i.e. less amputations and kidney failure). Guidelines can help remind physicians and other providers about aspects of care of which they may forget or overlook. When guidelines become policies, however, trouble ensues and judgment is removed from the equation. Presently, insurance companies distort guidelines into inflexible payment policies, which then distort the provision of care. Although I believe that some sort of universal health care is essential for America, leaving insurance companies in charge will only worsen an already desperate situation for health care providers and patients.
The solution? I posed what I believe to be a partial solution last week (universal pricing and paperwork) but the situation as I’ve already said is very complex and growing more so as we speak. The American health care system is like onions and ogres, multilayered. They also stink and no matter how you cut them, they bring tears to your eyes. In closing I would like to quote Voltaire regarding a dying and once noble art. “ The art of medicine consists in amusing the patient while nature cures the disease”
Dr. Mike Dostrow