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View Diary: Medical Crisis: The Shape Of Things To Come (245 comments)

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  •  isn't this what happened to Natalie Sarkisian? (0+ / 0-)

    I personally am for a board (a doc, a social worker and a few other reps) evaluating a patients quality of life and expected number of "good" years left before paying for expensive procedure (emphasis added) or giving a limited resource like a heart or other organ.  

    No! We don't need to continue and promote the HMO version of veterinary medicine.

    All we need to do, is work on removing profit incentives and indirect costs.  It is reasonable to think that those steps would reduce total cost by 30-40%

    Universal single payer won't cost, it will pay!

    •  you are a number (0+ / 0-)

      Whether you think so or not.  I am sure your mom thinks your special and your rat terrier too but, how do I decide if you get a liver when 4 people need one.

      Patient #1 Pediatric liver damage from accidental Tylenol overdose

      Patient #2 Hep C patient acquired through IV drug use.

      Patient #3 Hep C patient Nurse who was exposed at work.

      Patient #4 Chronic alcoholic with cirrhosis.

      2 and 4 are losers screw them they did it to themselves.  1 has the most years left though 3 helps people every day.  How do you decide there? Docs weigh out who is most compatible and who has the best chance of survival.  The girl a few  weeks ago in the news would have been killed by the imuno-suppressant drugs required for the new liver.  This is what I am talking about.  Everyone cannot have every therapy until they finally die.  There is not enough resources.

      •  the 24 version of medical practice (0+ / 0-)

        It would not surprise me to see you also argue for torture. You write a compelling scenario only because of its confounding simplicity and reliance on assumed stereotypes.  

        I don't believe that we have begun to reach the true limits of health care resource constraint.  But it seems you view health care delivery as a zero sum game.  If so, how  do you justify that one health care CEO deserves health resources equal to an annual compensation of $760,000 per hour?

        •  ahh come on... (1+ / 0-)
          Recommended by:
          Paid Troll

          17,000 people waiting on the liver transplant list, 5,000 livers a year... how in the heck do you not triage who gets what???? Every tranplant patient regardless of type, is evaluated by a physician, transplant surgeon, social worker, and psychiatrist.  They are assigned rankings by the folks that maintain the list, and are based on a number of factors... and yes some of them are strict criteria based on other illnesses, habits, etc.  Unless you have about 12,000 livers hiding somewhere I dont think your arguement that triaging pts is akin to torture floats.

          •  i didn't mean say you don't triage ... (0+ / 0-)

            obviously there are many circumstances where triage is mandated. Triage directed by the ER physician is well supported.

            What I think though is that we are too frequently resorting to triage practice to keep a beyond broken, unfair, unhealthy and otherwise dysfunctional so-called health care "system" functional at some level.  We need to change the system and get it off life support

            I didn't mean to equate triage with torture, only that the 'Troll's scenario was about as well developed as people who use the 24 scenario of a ticking clock to justify torture.

            The bad part of the board review process (particularly situations similar to Natalie) has been the proven circumstance of board members benefiting from denying treatment/procedure.

        •  Torture (0+ / 0-)

          ? That is a leap, my scenario is both realistic and complex.  Answer it does the nurse or the child get the liver.  Or the drug addict or alcoholic.  There is no stereotype in a scenario.  I did not say patient presents with NASCAR shirt and beer gut so he must be an alcoholic.  All the conditions listed are realistic possibilities and unless an organ is familial, they are the types of decisions transplant boards evaluate.  

          No CEO deserves that much, my other problem with our system is non providers making decisions.  Our COO at my old hospital was 27 with an MBA and no CPR card, he had never even fluffed a pillow.  With out a demonstrated capacity to provide compassion you should not hold the checkbook to facilitate care.

          But yes I am for water boarding and or beating the ever loving you know what out of a terrorist for information.  

          •  "my scenario is both realistic and complex" sure (0+ / 0-)

            This is very complex and insightful-

            Patient #2 Hep C patient acquired through IV drug use.

            This is all that your board needs to consider in order to make a life or death decision?   No age, other health considerations, drug usage history, family, education, job, responsibilities, or support environment is taken in to account?

            And maybe this (no stereotypes here?)

            2 and 4 are losers screw them(emphasis added) they did it to themselves.

            The complexity of your patient review analysis is surprising. And, unfortunately probably shared by many for-profit providers.  In its defense it is probably costs very little.

            •  I applaud your humanity (0+ / 0-)

              And lack of ability to make important decisions quickly.  Since I am a medic going to medical school this fall let me tell you how it is.  Some people make decisions.  Do we or don't we: Go to war, get fries with that, treat this patient, treat that patient instead.  

              Choosing not to decide is still a choice and as pointed out above there are not enough livers (or numerous other resources) so someone has to make hard decisions.  I am glad it is open to review and that people complain about the process. Otherwise things like race and gender would play a greater role in the quality of care people receive. And yes minorities seeing the same physician as whites often receive care of lesser quality.

              http://search.nejm.org/...

              I will say it again if i have a liver for a pediatric patient or an alcoholic screw the alcoholic, and I won't apologize.  Look up the criteria, you'll see the medical community agrees with me although they are not as blunt.

              •  no they don't agree with you (1+ / 0-)
                Recommended by:
                TheMomCat

                get fries with that

                I worked with renal physicians for a number of years in the largest teaching hospital in New England.  Transplant decisions are not made as simply and mono-dimensionally as you write.

                Hopefully medical school will teach you that and allow you to appreciate that the practice of medicine is the combination of science and love.

                •  Twist my words (0+ / 0-)

                  Mono = one

                  Age, Disease, Means of infection are three different categories, while ignoring all the surface proteins and blood types as well as geographic proximity to the donated organ. You continue to suggest simplicity and lack of realism in my argument where it does not exist.  

                  BTW patients and family members continually compliment me on my bedside manner and compassion.

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