Rational health care can be misconstrued to mean what is economically sensible treatment as opposed to what is humane treatment. Although rational care may be good, it isn't necessarily humane. The objectives of medicine, business, and law are not always aligned harmoniously.
May 10, 2009
News-Times
Danbury, Connecticut 06801
Syndicated columnist Ellen Goodman emphasized in her May 8 article “Rationed health care may be rational” that doctors and patients need to talk about just how much care a terminally ill patient should receive. She also pointed out that doctors don’t talk about death as much as they should because they consider death a failure of their skills.
This is all true but doctors sometimes “over- treat” even when doing so will not change the final outcome for fear that the family might think the doctor was incompetent and maybe even sue him or her for malpractice.
Thus for some doctors doing everything is the safest way to practice even though it is costly and may do nothing to improve a patient’s quality of life. Doing everything is called “defensive medicine” and is so common that it has come to be considered good medicine.
Lawmakers are beginning to understand this terrible dilemma that doctors and patients face. In one sense, it is a result of medicine’s great advances. Kidney dialysis, heart bypass surgery, and new methods of treating cancer for example, give the impression that no disease is incurable. But there are situations when good conversation and less intervention, as Ms. Goodman put it, is best.
In those situations where a prognosis is poor, a good relationship with a personal physician is very helpful. If he has known the patient for some time he probably can help the family and patient arrive at a humane decision. Also, when a prognosis is poor there are usually several doctors involved. Decisions not to over-treat are usually arrived at by not one but several doctors working together. Hospitals also have ethics committees to help doctors and families make difficult decisions.
Perhaps we should be talking not about rationed care but about humane care.
Ed Volpintesta MD
Sunday, May 10, 2009
Tuesday, May 5, 2009
Remedies: New Media
"Ever regret being born a girl, or worse, being pregnant with one? Do you have that nagging suspicion that junior's a fairy? Some days, don't you just feel too brown to fit in? For the first time, a new line of miracle Remedies have been developed to address these cultural neuroses. Our products incorporate the latest medical breakthroughs, enhanced by ancient Chinese secrets that comply with the highest standards in numerology, filial piety, and Confucian mythos."E-literature, medical marketing, and folklore collide in Remedies, a work-in-progress by new media artist Monica Ong, who creates narrative spaces that examine cultural anomalies in public health.
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Machiavelli and righteousness
May 5, 2009
New York Times
Re “Stumbling Blocks on the Path of Righteousness” (Science Times, May 5): The dichotomy between what people should or ought to do and what they actually do when placed in certain situations is universal and not new.
The Renaissance humanist Niccolo Machiavelli back in the fifteenth century approached realistically the problem of righteousness in politics. In his famous books The Prince and The Discourses he gives examples of leaders having to do what outsiders might consider ruthless or opportunistic in order to maintain power and provide for the common good.
Whether providing for the common good or for one’s own good, it seems that
righteousness, like beauty is often in the eye of the beholder and like many moral dilemmas is not so easily defined.
Ed Volpintesta MD
New York Times
Re “Stumbling Blocks on the Path of Righteousness” (Science Times, May 5): The dichotomy between what people should or ought to do and what they actually do when placed in certain situations is universal and not new.
The Renaissance humanist Niccolo Machiavelli back in the fifteenth century approached realistically the problem of righteousness in politics. In his famous books The Prince and The Discourses he gives examples of leaders having to do what outsiders might consider ruthless or opportunistic in order to maintain power and provide for the common good.
Whether providing for the common good or for one’s own good, it seems that
righteousness, like beauty is often in the eye of the beholder and like many moral dilemmas is not so easily defined.
Ed Volpintesta MD
Monday, May 4, 2009
No time for good history-taking
Letter in American Medical News
Letters to the Editor - May 4, 2009
Insurers responsible for time pressures that undermine taking a good medical history
Regarding "Changing history" (AMNews, April 6): It was timely to mention the importance of taking a good history.
Clearly, history taking has taken on a subordinate role, because little time is available time for it. The overuse of lab and imaging studies often fill in as substitutes for engaging patients in their medical narrative, and electronic medical records make it seem that doctors are more interested in data entry than on connecting with patients.
Of the three obstacles to history taking, the time factor is the most critical and the most difficult to resolve. Time is needed for patients and doctors to engage in real dialogue -- not the sorry surrogate forms that patients answer in waiting rooms by checking off what illnesses or surgeries they might have had, or what their marital status is, or whether they smoke.
It could be said that the single greatest wound inflicted by insurance companies on the medical profession is forcing doctors to see more patients than they ought to.
For doctors who want to take a good history and perform the single greatest act that separates medicine from other professions, the only way to get more time is to see fewer patients and practice at a pace that allows good history taking.
This will precipitate a public outcry, but it may be the only way of enlisting public support to wrest control from insurers and put it back into the hands of doctors. Experience has shown that it is impossible to build a humane health system that is dominated by profit-making insurance companies.
--Edward J. Volpintesta, MD, Bethel, Conn.
Letters to the Editor - May 4, 2009
Insurers responsible for time pressures that undermine taking a good medical history
Regarding "Changing history" (AMNews, April 6): It was timely to mention the importance of taking a good history.
Clearly, history taking has taken on a subordinate role, because little time is available time for it. The overuse of lab and imaging studies often fill in as substitutes for engaging patients in their medical narrative, and electronic medical records make it seem that doctors are more interested in data entry than on connecting with patients.
Of the three obstacles to history taking, the time factor is the most critical and the most difficult to resolve. Time is needed for patients and doctors to engage in real dialogue -- not the sorry surrogate forms that patients answer in waiting rooms by checking off what illnesses or surgeries they might have had, or what their marital status is, or whether they smoke.
It could be said that the single greatest wound inflicted by insurance companies on the medical profession is forcing doctors to see more patients than they ought to.
For doctors who want to take a good history and perform the single greatest act that separates medicine from other professions, the only way to get more time is to see fewer patients and practice at a pace that allows good history taking.
This will precipitate a public outcry, but it may be the only way of enlisting public support to wrest control from insurers and put it back into the hands of doctors. Experience has shown that it is impossible to build a humane health system that is dominated by profit-making insurance companies.
--Edward J. Volpintesta, MD, Bethel, Conn.
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