This morning on
NPR's Morning Edition, Atul Gawande was interviewed to explain the difference between Rationing Care and Rational Care. He gave a nice, clear, straightforward explanation that Health Reform will never be about rationing. Rather, providers and patients need to make educated, joint decisions (the art of medicine) regarding rational care. He proceeded to explain that Health Reform is necessary. That continuing 'as is' will lead us to an essential meltdown with Medicare going bankrupt very shortly. He also spoke of our country's need for more Geriatricians and Gerontologic Nurses--that regardless of the 4-5 year expected time to transition our current uninsured patients into the new health system, that our elderly population (most of whom will have Medicare) is expected to double and we don't have the existing capacity in workforce to accomodate everyone.
What I always find remarkable about Gawande's writing and interviews is his ability to translate issues into easily-understood language. He helps to clear the air of the voluminous mis-applied, mis-defined, mis-used language that is out in the public and press.
Comments
I was extatic when I listened to this piece on the way to work today, especially when he said we need more Geriatricians and Gerontologic nurses. I couldn't agree more that we are coming to a crossroads where the population is getting older but the number of health care providers who have a focus on aging is decreasing.
I also found the idea of rational vs rationing health care to be a clear and useful way to phrase the arguement for health care reform. I know far too many people who recieve unessesary and likely harmful diagnostic tests. CT scans for simple headaches, coronary calcium scores in healthy 50 year olds, whole body scans, or screening mammograms in 20 and 30 year-olds (or 90 year-olds). There is an increasing amount of evidence that radiologic procedures such as CT scans may increase (although only slightly) ones risk for cancer. Why take the risk for something that is unlikely to help?
For the NY Times Article see:
Study Finds Radiation Risk for Patients .
With the push for CT colonography, cardiography, etc. these numbers are just going to continue to rise.
-Chrissy Kistler
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Paige – here is our official stance on metaphors. You can use them if you are thinking outside the box, attempting to grab the bull by the horns, building bridges, or holding someone’s feet to the fire. [In truth, we don’t really care if you use metaphors. We are just happy you are commenting!!!]
Even when we become more "rational", there is still a high likelihood that our contry could "ration" care. Rationing defined as denying potentially beneficial but overly expensive therapies based on their cost. This is indeed the potential implication of cost effectiveness analysis. If society sets some threshold such as $100,000 per QALY for coverage decisions then we will indeed be "rationing." To be clear, physicians need to be involved in these discussions but at the policy level, not the patient level.