Full post here (once archived, it won’t be free)
McAllen, Texas, Gawande argues, could learn a lot from the Mayo clinic’s method of de-incentivizing some ways doctors make money, and feel pressure to make money:
“Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can.”
Some collectivism may be necessary, and practical, to reduce wasteful spending. It also could help to keep the discussion away from the top-down, and often once removed, visions of politics and political ideology.
My sister is a 71 year old woman who had severe back /leg pain for which she had sought relief for many years. She also had scoliosis which had gotten progressively worse. She was comfortable sitting but standing or walking were very painful.
She was obese had smoked for 40 years as well as consumed fairly large quantities of alchohol daily. She had also had 5 abdominal aneurysm stents. She also had evidence of a past MI.
Her Dr. in his infinite wisdom preformed an 8 1/2 hour surgery without benefit of a cardiology exam or bone study. After the surgery she developed so many complications including MRSA cardiomyopathy a cracked bone below the incision and now seems to have had a stroke for which he has asked for a neuroligical work-up. She is alone except for me and my family. We are faced with moving her to our state and finding a suitable Nursing facility for her which is the most depressing task. Though she has trouble finding words and her short term memory is very bad, she is still who she was, which is a vibrant, bright person with a good sense of humor.
Instead of telling her she would be best served by getting a wheelchair to get around he decided he was a miracle man with his hands so now she is unable to do virtually anything for herself at all. it takes two men to lift her and on and on.
She is a perfect example of “The Cost Conundrum”. Wouldn’t it have been better for instance, if there had been a committee decision instead of a quick work-up by a Hospitalist/Internest who decided she was a candidate for this terribly invasive, debilitating surgery. Not only has her life been ruined but also mine as her sister as well as my children and grandchildren. My time/energy will now be used to help her have as much dignity as possible which isn’t much.
Sincerely,
Connie Robathan
Connie,
My sympathies for you, your sister , and your family.