*A Pacemaker Wrecks a Family’s Life* Can faith in medicine be restored? #hcsm #hcr

When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.

via nytimes.com

 

It saddens me to read articles like this…

• How many other patients feel this way? 
• The majority?  
• Why do they feel like this?  

I see many many patients each and every day that still have *faith* that their physicians are acting on their behalf with the best of intentions. However,  I also meet a handful of patients each week who are very skeptical and cynical about the motivation that may lie beneath my recommendations.   

I fully understand (and agree with) this woman’s position. A number of pertinent issues are brought to the surface by this article, the largest of which, in my opinion, is the issue of end of life care...  I do not want to go there… today.   This is a tremendous problem and represents an enormous cost burden to society, and it can become an enormous painful, emotional and *costly* burden to both the patient and their family.   

But I digress…. 

I found this article very intriguing… and very enlightening.  I have long felt that the trust patients once had in their physicians is eroding.  Many will blame the likes of Obama who states we would prefer to amputate a leg for $50,000 then to treat the underlying cause—diabetes.  

Many will blame the physicians themselves… After all, they are trying to care for patients and run a business. In today’s environment that can be a very tough juggling act for many of my non-procedural colleagues. They need to remain in the black, and in many instances are trying to avoid being sued.  This leads to the ordering of poorly indicated testing or procedures, or it leads to the provision of unneeded DME services such as braces, and perhaps even poorly indicated surgery.  

This article (potentially) also brings up the failings of the current fee for service (FFS) model.

• Did the cardiologist in this case put a pacemaker in because he needed the money? 
• Did he put it in because the patient would have died without it and was afraid of being sued? 
• Or did he honestly think it was in the patient’s best interest? 

 I hope it was the later.  In this particular case I doubt we will know the answer to that.  But look at the enormous *cost* and *burden* that was set upon this family because of this one decision.  It’s the sad reality of the dramatic effects (some of which we can not possibly fathom) that a relatively *straight forward* decision making process can have.  

We need to:

• focus on modifying the fee for service model…
• embrace (reimburse physicians to adopt) a patient (family)-centric model that engages the values the patient and family bring to the table—
• deal with end of life care.  
• deal with the fear of frivolous lawsuits that motivate some of these decisions. 

If you think that simply cutting fees to providers is going to solve the cost burden of our health system you are sadly mistaken.  The exact opposite will occur— as the *system* seeks to maintain the status quo the simple truth is that  cases like this will become ever more prevalent and the *cost* burden to the system, the patients and the families will simply increase along with it.