Part Deux

[PaulaJo]

I just posted about this on the other thread.

[leigh]

What about the technology in medicine now as compared to fifty years ago ? An example... heart attacks. Bedrest used to be the prevailing treatment for heart attacks. Certain cancers now are no longer automatic death sentences like they once were.....people with degenerative joint disease had no options for arthoscopy.... it goes on and on. This technology costs money.

Fifty years ago, I am sure many people terminal went home to die, where as now they are treated aggressively in hospitals. Life support technology is more complex now. We now keep people alive artificially that would never have been possible fifty years ago.

It all goes back to public health. America is filled with obese smokers, we don't excercise, we drive everywhere, we eat poorly.... we have hispanics flooding our border with a genetic presdisposition to pack on the pounds and become diabetic...
as Ryan knows, the ICU is filled with the harsh effects of chronic illness such as emphysema... complications from unmanaged hypertension... blah blah blah.

Fifty years ago, I am sure people walked more, ate less fast food, and led simpler lives.

[CrankyChrissy]

Blah, blah, blah? That made me laugh. Only a nurse would say that.

Does the advanced state of health care technology mean it would be impossible to simplify? Would it be undesirable to simplify? Why do we have to use technology with wild abandon the way we do? With all this technology do we really have a better health care system than we had fifty years ago? True, we can do amazing, wonderful things we couldn't do before, but generally speaking, do patients get better care?

Consider HMOs and their penchant for denying treatment. Setting it as a given that insurance companies are the spawn of Satan, what about doctors? What happened to the Art of Medicine?

Aren't there any doctors who have enough skill to treat patients without ordering every test known to medicine? (Malpractice litigation rears its ugly head.) Do any medical students apply to medical school because they want to heal and help people? What prevents doctors from seeing patients for reasonable fees? (I saw a doctor in Orange County who charged $30 for an office visit, if you paid in cash. Probably not reported, but. . .I knew he was competent because I had some of his patients in the hospital.)

I'm tired just thinking about it. I guess it all comes back, as always, to the individual and changing the habits and expectations of consumers. And the passive acceptance by the populace that insurance companies can't be stopped. And the inhumane solution of killing all the lawyers.

[CrankyChrissy]

Should have read your post in the original thread first, Paula. You covered a lot of this.

[PaulaJo]

I started to copy it here but it is kindof long. The local doc seemed very thorough, lots of commonsense and very down to earth.

[insenescence1]

Denying treatment is not a practice exclusive to insurance companies.

Gov't payers also deny treatments; people need to realize that before they preach that a single gov't payer is the way to go. The difference is that you can sue an insurance company for payment; try suing the gov't.

The major benchmark used when ranking countries is life expectancy; life expectancy seems to be the obsession. This benchmark can be remarkably improved by removing CHOICE from people's lives. It has far less to do with our remarkable and incredible health care capacity (that entices sick people from all over the world) than it does with the decisions we make in lifestyle before we get sick...but we can't make people exercise, and eat healthy food (and healthy portions), etc.

In the end, after so many of us are done ruining ourselves, we expect everyone else to fix our bad decisions, and then we turn to blaming the insurance company, the gov't...anyone but ourselves (it's never our fault as an individual, we are so entitled). The gov't we don't want interfering in our lives, but the same gov't that a certain population wants to interefere in my financial life to fix the years of bad decisions by others.

[leigh]

I think you have to use technology wisely... in other words... do you really need to keep the brain dead trauma alive for one week, with the pressors, the ventilation, the pet scans, etc ? It is a trial, I have noticed, to declare someone brain dead, and then when they are declared brain dead, they are often left on life support until they slide into organ failure and require more and more care. By then, you have spent thousands, probably more, on a brain dead trauma that had no hopes of ever recovering. This happens repeatedly, daily.

How about the respiratory failure who is 89, with dementia, and is trached, peg tube placed, and kept on a low dose dopamine drip until he or she can be shipped back off to the nursing home ?

Is this using technology wisely ? I can't tell you how many times I have seen families disregard the medical opinion of the doctor and opt to keep their unresponsive family member on life support for weeks. How about doing partial hip replacements for frail, demented old ladies in their nineties ?

These are the questions no one really asks, or wants to deal with.

A beginning step would be hospice education, and capping malpractice fees, and seriously reigning in the greedy legal establishment.

A second step ( watch out conservatives ) would be to impose a heavy consumption tax on cigarettes, and a smaller consumption tax on alchohol. Raise the smoking age to 21.

How can we simplify technology ? I think a good start would be to educate family members about the ICU course a terminal patient will take. Having them watch codes is a good start.

If the healthcare system , fifty years ago, was structured in the way that patients saw a family doc that knew their health histories well, then yes, in some ways our healthcare system is worse now, because patients don't get the rapport with their docotros that they used to.

However, with my health history, I would have been dead after the birth of my first child, and my daughter may have died as well. I had severe preeclampsia and my daughter was 31 weeks at birth.

Using technology wisely today would be to do everything to save my child, since her apgars were 8 and 9 at birth, and , if I had suffered a stroke with brain damage to the point that I needed life support, ( brain stem damaged ) then to take me off the vent. If I required any life support to stay alive, yet I was comatose, unresponsive, severly brain damaged, etc. then let me die, just keep me comfortable with sedation.

[CrankyChrissy]

These two posts are from Bush Talks About Healthcare in Cleveland.. I thought they were interesting and opened this thread in case anyone else wants to talk about Ryan's question. Posted By: Ryan,RN Fri Jul 20 (08:56 AM EST) what I like is the 'small business' feel - not the conglomerate one - whether that is the big health care systems or the government. Isn't small business how this country was built? Question: How was health care - say - 50 years ago - actualized. Not kidding. I was raised in the Navy so we had ready access. Since I was a child I never was aware about the rest of the country. What changed, what happened, were people satisfied or without care then too? Posted By: faithforever Fri Jul 20 (09:33 AM EST) NO WAy Ryan- people got great care 50 years ago- from their FAMILY doctor who was a trusted member of the community who came to your home if needed and charged 15 dollars for an office call. (I know, I've seen patient ledgers from 1968). Paging Marcus Welby M.D.! It sounds like where you live and where my mom's doctor is it's still like that somewhat. Stick with it and don't ever move!

[peady2]

Dusty-I agree with a lot of what you are saying. But do you realize that some of your statements are not very conservative? Capping malpractice fees? I thought that in our capitalist society the aim is to make as much money as you can. Why should the lawyers be penalized just because they are good at what they do and can work hard enough to get their clients big bucks? Should we also cap doctors' fees? Maybe there should be a cutoff age for certain procedures, or docs need to be reined in and caps placed on the more costly procedures they do. Maybe some people think nurses make too much. You see where I am going here.

"If I required any life support to stay alive, yet I was comatose, unresponsive, severly brain damaged, etc. then let me die, just keep me comfortable with sedation."

Are you saying here that you should be allowed to starve and dehydrate to death? Isn't the conservative viewpoint that this would be murder? That's how they felt with Terri Schiavo. It was only the lousy liberals that felt she should be kept "alive" by artificial means indefinitely.

Maybe you are a closet liberal {{{{shudder}}}}!

[peady2]

BTW, dusty-another little real life anecdote I learned the hard way. If you win any malpractice judgement, Medicare/Medicaid takes whatever they paid for the medical care received during the time of the malpractice right off the top of that judgement. (Maybe private insurers do as well). So if you successfully sue a doc for malpractice and are awarded say $250,000 and medicare paid $100,000 for the hospital stay where the malpractice occurred, than medicare gets their $100,000 back from the plantiff's award. The lawyers get their full fee plus expenses, then medicare takes their cut from what's left and then the family gets to keep what's left. Funny huh? Kinda reminds me of that old I Love Lucy episode with the Lucky Buck worth $200 bucks. Lucy manages to lose it and she and Ricky and Fred and Ethel agree that they will take any expenses used to try to get it back out of the winnings. The Buck winds up at the laundry, and Lucy gets starched but they manage to get the Lucky Buck back. They cash it in, and after expenses they are left with....one dollar.

It really isn't so funny in real life. But since our objective was met-the doc had to pay-we were OK with it. And that is how I can joke about it. But I wouldn't wish the experience on my worst enemy.

[nursey57]

Dusty-I can't believe you made such a racist comment about Hispanics that "pack on pounds and become diabetic". Shame on you!

[Anonymous]

In, do you always choose wisely in all that you do?

Your point is well taken that we all need to eat right, exercise, be responsible for our own health to a very large degree.

I'm just wondering, though, if you personally always or usually make wise health decisions because you sound so dang moralizing.

Perhaps you can offer some suggestions as to HOW people can choose more wisely when they also battle poverty, depression, and other things, like perhaps being saddled with caring for children and elderly or invalid family and just have so little time and money for themselves. Please address this. I have an idea but I'm just wondering if you do.

[PWhite]

Well, of course, I, for one, cannot help but agree with everything said my our esteemed leader, "President Bush" with regard to "Health Care".

In addition, I totally trust his reasons for sending our military into Iraq.

I am also very sure that as a result of his actions and policies, peace will prevail in the Middle East.

P.

[leigh]

Nursey57,

Relax with the political correctness... its okay to point out the obvious. Public health journals also discuss the rampant diabetes and obesity in the hispanic community, only they don't use the phrase " pack on the pounds " Second generation hispanic americans suffer greatly from obesity, in fact there was a major study just completed on this very subject. Hispanics also use public health services in greater numbers, this too is also reported in most magazines in newspapers... so in regard to our heavy medical bills in this country, I think some of it can be traced directly to the hispanic community. It is a no brainer.I live in central California now, and I see many chunky hispanics here, and chunky kids. Of all the kids in all the ehtnic gruops out here, I would have to say hands down hispanic kids are the fattest. It has to be in the genes.

[leigh]

You take the gruop of fat kids I saw the other day at the playground..... give them 30 years, half of them will be in an ICU with kidney disease or some other complication.... and the medical bills will be unreal in this country. By then our kids will be paying them.