Innovation and compassion in health-care

Here is my column in the  Greenville News, Sept. 27, on the unique characteristics of American health-care.

https://www.greenvilleonline.com/article/20090927/OPINION/909270306/1016/Health-care-represents-America-at-its-best

The text is below:

Compassion and technology; a marvelous, expensive combination

Does anyone realize that the chaos of modern American health-care is not a tragedy, but a triumph?  We’re so busy trying to fix what isn’t broken and ignoring what is, so busy casting stones and casting doubts that we are blind to what we have.

I have practiced medicine in this labyrinth for 16 years.  I am an emergency physician. I practice in what may be considered the ‘epicenter’ of modern medicine.  Not for its importance, necessarily, but for its strategic location in the health-care system.  That is, almost every specialty, almost every kind of human illness or injury, ultimately finds its way to an emergency department.

Therefore, I have seen the good and bad of American medicine.  I have seen fantastic physicians and mediocre ones.  I have cared for patients in dire distress, and those who were profane, abusive and manipulative.  And I have watched as policy-makers, administrators and surveyors have caused both improvements and inefficiencies.  But on the whole, I’ll take it any day of the week.  Because American health-care represents, for all its limitations and problems, the best that America has to offer.

Technology meets compassion

Why would I say that, when there are uninsured persons and failures?  When people slip through the cracks and the cost of modern health-care is enormous?  I say it because modern medicine represents a confluence of two great American traditions:  compassion and progress, both of which conspire to cause the marvelous madness of modern health-care.

As many realize, emergency departments see all patients, regardless of ability to pay.  This occurs because of a law passed in 1986 called EMTALA, or the Emergency Medical Treatment and Active Labor Act.  Legislators, concerned for the plight of the poor, enacted this mandate; then failed to enact any means of compensating hospitals or physicians.  Still, emergency department visits are higher than ever, care is better than ever and medical practitioners keep coming back to ‘do the right thing,’ at all hours of the day and night.

This behavior is not limited to my specialty.  Surgeons care for drug-addicted victims of gun-shot wounds; internists and oncologists provide care for the oldest and sickest, despite the gravity of their situations.  Impoverished premature infants are seen in high-tech hospitals that are the envy of the world.  Cardiologists and neurologists help us to survive heart attacks and strokes that, not so long ago, would have left us consulting with morticians instead of physicians.

The government, and the physicians, nurses, nurse practitioners, physicians’ assistants and others who care for the sick, are all possessed with a constantly renewed surplus of concern and compassion, which combine with technology to make American health-care the incredibly complex, expensive thing it is.  And that’s the problem, isn’t it? We all desire compassion; we simply want it to be dispensed at a much lower cost.

But our superb technology is expensive.  Our research is always changing, new drugs and procedures always being produced.  We clinicians stand on the shoulders of researchers and business leaders who provide the means by which we can treat even the most extreme conditions, and often return the sickest individuals to their regular lives.

American health-care happens at the nexus of compassion, science and industry.  The desire to treat everyone causes increased cost. The constant supply of new ways to treat everyone causes increased cost.  And our general desire to give the best to everyone in our typical, democratic way causes increased cost.

Do you doubt me?  I’ve seen the poorest, drug-abusing, cigarette-consuming individual receive the best care imaginable for lung disease, renal-failure, cancer or trauma.  We, as a nation, as a profession, are somehow tied to the Golden Rule, and we have difficulty saying no to anyone; not for fear of litigation, but because it might be us, or our loved-ones, in need in the future.  American government, professionals and tax-payers try to give the best of all, to as many as possible, because we view other humans as having transcendent, unconditional worth.

I don’t know the answer.  I know suffering remains.  I know improvements can be made.  I hope that wise leaders engage in some few, wise reforms.  But I think we need a moment of congratulatory pause.  Our health-care problems are less the symptoms of a national disease than the side-effects of an enormous historical accomplishment.  America, land of expensive care and remarkable compassion, should think carefully and move slowly before we constrain the characteristics that make our nation, and our national health-care, exceptional.

Edwin