Rational Healthcare

In reading an interview of Dr. Otis Brawley’s new book, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America,” I came across the following sentences by Brawley that mirrored by own thoughts after more than 30 years working in health care. A lot of people didn’t seem to realize that in a lot of the discussion, we’re talking about human beings who are suffering because of lack of health care, and sometimes we’re suffering because of overuse of health. People are so focused on fears about rationing of health care. The talk should not be about rationing health care but about rational health care. So much of what we do in health care is irrational. http://well.blogs.nytimes.com/2012/04/20/how-doctors-and-patients-do-harm/

This morning I posed the following question to myself, what three things could be changed that would create a more rational healthcare system? While I do understand that putting these three words together is a bit of an oxymoron, below is my “first pass” thinking. What would yours be?

• Those who use healthcare and those who provide it accept that death is part of life. Often, more money is spent at the end of a person’s life then at any other time. As much of a concern as the fiscal piece is, the person and those that love them, can loose quality (and even quantity) of life as well as reduce, or even eliminate, the ability to bring closure.

• We accept the responsible for the choices we make and their outcomes. One of the best examples of this came from a nurse working in hepatitis C (HCV). She was beside herself about a patient, whom they had successfully treated for the virus, who then continued to engage in behaviors so he became re infected. While he wanted treatment, he also wasn’t planning on stopping the behaviors that caused him to be infected. She voiced her concern at a meeting where a number of those in attendance were HCV infected. A number of them, as well as some of the providers, were clear that this individual should not be treated until they were ready to commit to their own well being. Interestingly, some believed that it was the responsibility of the provider to heal the patient regardless of the choices the person made. While this is HCV, which comes with a dark cloud over it because the primary reason for infection is IV drug use, is this really all that different from the diabetic that refuses to give up sweets, alcohol and a sedentary life style?

• Understanding that more testing and treatment don’t necessarily translate to better outcomes. Providers order more tests and treatments then are necessary for a host of reasons, with two of the leading ones being fear of being sued and “the patient wanted something done.”