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James Hamilton, M. D.
I guess I look at medical care from a different and relatively simple perspective. Here are a few random thoughts:
There is no doubt that people need to take better care of their own health. Bad habits often result in bad health. As Dave's father said about television creating couch sitters, so has today's electronic world created so many jobs that seat people in front of computer monitors.
Sick people, regardless of how they got that way, deserve to be treated by appropriate medical personnel. In the case of doctors we took an oath to do so. In many current socialized systems and other models, both in effect and proposed, the choice to treat and the kind of treatment a patient can receive is determined by those who do not treat the patient.
Technology and advances in therapies are cascading rapidly along with their costs. Cost obviously has to be taken into account.
Where do you draw the line and who should draw it? Who is smart enough to know the life expectancy of an INDIVIDUAL patient with a serious disease?
Statistics are guidelines not absolutes. It is very easy to apply a statistic to an unknown person, but not so to a loved one.
Everyone should have Advanced Directives and a Durable Power of Attorney for Medical Decisions.
Palliative Care needs to be explained better to patients with terminal illnesses and the limits to pain control need to be discussed in more detail with chronic pain patients.
Is the life of a homeless alcoholic with TB living on the streets less worthy of treatment than a wealthy executive? Should Narcan be given to every opiod overdose victim whether it was accidental from a legitimate prescription or from oxycontin obtained from a drug dealer on the corner?
Who gets the liver transplant: an alcoholic millionaire or an impoverished person with cirrhosis from Hepatitis C who does not know how she contracted it?
I could go on and on.
America is different from the rest of the world in so many ways. Yes, we are expensive and costs need to be better controlled. But, at what cost (no pun intended) to our compassion for the sick? It is easier to talk among ourselves about restricting treatments to sick persons than to look them in the eye and say "sorry, you (or you child) will probably die anyway - statistics tell us only X% will survive".
In medicine there are three basic paths in dealing with patients: public health personnel who are concerned with populations and groups, pathologists who view patents and their tissues on a microscopic level or after their deaths and clinicians who deal with individual, living patients who may be healthy or sick - and eventually they all become sick in some way if they live long enough. I chose to be a clinician. There is a saying among internal medicine doctors that the definition of a well patient is "one who has not yet completely been worked up (evaluated)".
Jim
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