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Health Care Quality is Not Just Statistics



Liberal advocates for health care reform point to evidence based medicine as the panacea to a burgeoning dilemma. A true health care change should additionally be based on acquiescence to what contributes to patient satisfaction and how our impious culture negatively impacts this goal.

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Medical care developed centuries before humanity began to understand even the basics of science on how the body works. Healers in primitive society often could do little to help the actual condition afflicting the sick, the injured, or the dying but they played an important ritualistic role as a representative of a society that valued that an individual who was suffering merited attention and special care when ill. Today as we talk about the importance of spending our limited health care dollars on quality medical care it's important to remember that health care is not just a statistic. Today the major focus of health care reform is to establish guidelines for the treatment of conditions based up well respected scientific studies that have followed strict requirements instead of relying on just traditional anecdotal experience. As a greater portion of individual income and national GDP each year has gone to health care expenditures this seemed a cogent objective way to approach the issue of justifying costs. The Institute of Medicine has further defined health care quality as having six goals: patient safety, patient-centeredness, effectiveness, efficiency, timeliness, and equity of application. Using this concept one can compare for example the costs, risks, and outcomes of two different treatments for the same disease. However, applying this measuring tool to health care systems as a whole is not so simple. Although major advances in the science of understanding how the body works are well accepted by the general population, how do we explain why non-scientifically based methods of treatment often called “alternative care” still continue to enjoy strong popularity. Felicity Bishop, a post-doctoral research fellow in England found that 46% of the population there utilized alternative treatments during their lifetime. Her research and others have found patients seek like treatments because they are dissatisfied by conventional medicine's technical nature or the interpersonal interaction between patient and therapist. Practitioners of alternative treatment who are successful in drawing large numbers of satisfied patients exhibit common themes. Patient participation in the therapy process gives them a sense that they are controlling their own destiny versus just being passive receivers of conventional care. Deep seated beliefs in natural treatments having advantages over artificial chemicals or remedies are reinforced by alternative practitioners. Many people who consider themselves religiously spiritual or cause driven dislike the cold concept of the human body as solely being a machine and find the “mind-body” connection connoted by alternative therapies as rewarding. Perhaps another way to look at health care is to ask the question what do patients really want from the health care system? Severe acute conditions threatening life or limb or causing horrendous pain makes for obvious conclusions but in reality make up but a small part of the millions of interactions among patients and the health care system. Today, just as in ancient times, many of our visits to the doctor really relate to wanting to be assured that we will continue to be in control of our destiny and have a clear vision of our future. Scientific “outcome “ studies may denote to the doctor to whom we are complaining about a pain that cancer is a very unlikely diagnosis nevertheless that uncertainty makes us uncomfortable. Americans like to believe that we are immortally young and can be cured of any illness. Why should we consent to a guess when there may a test that we will not have to personally pay for that tells us with great certainty what is our condition and by inference what our future is? This is the crux of the dilemma facing health care reform today. We have legal system that preaches if we are wronged we have a right to millions of dollars and we have a dominant political party that flagrantly spends trillions of dollars without concern for any thrift. These deeds contribute to the false belief of a significant portion of America that there is no limit to available health care dollars for health care. There is a perceived difference in the standard of care given to prominent members of society versus the common folk. If a professional athlete injuries his knee he gets a MRI often within hours. The President of the United States gets “routine physicals” at government hospitals which consist of every possible diagnostic test and an evaluation by a team of physicians often lasting several hours instead of the 15 minute physical that Uncle Joe gets at his family doctor. One great difference among the European countries who have adapted somewhat socialized medical schemes (they still have the private outs for the well to do) and America which must be contemplated in designing our medical system is the culture contrast on how we perceive aging. American society and movies often imagine everyone never gets older than 35 and will live forever. Aging makes us very disgruntled. We have very few mature female sex symbols and rarely see movies demonstrating significant value in the life of the elderly whereas in Europe there is a much greater acceptance of aging and mortality. In Europe someone presenting to the hospital with chest pain thought to be a small heart attack or angina that could be signs of a possible heart attack is often sent home with aspirin if they are stable. Statistics say that for the vast majority of people treated in this manner, most will survive and only a few will die at home. This preserves significant amounts of health care dollars and reduces hospitalization significantly which can be applied to other uses. In the United States these patients are admitted to the hospital because studies have shown that should they get a complication such as a cardiac arrhythmia rapid treatment in hospital has a high chance of saving their life. Both of these treatments can be justified by statistics. The mathematics of outcomes research cannot tell us which treatment is right or wrong. All societies must cope with the fact that there is a limit to the total expenses which can be put to health care. The hardest question is how to divide that spending? The biggest fear that American's have about health care reform is that they will have no choices in their personal health care. Even if “scientific studies” proclaim that only one treatment should be given the world wide experience suggests that almost half of the population will likely want alternative treatments regardless of whether they can be proven scientifically valid. Creating a rigid no choice system as proposed by liberals will be politically unpopular not only at the onset of its inception but increasingly over the time of its administration. Another big issue is raised by the dilemma of heart disease mentioned above. How do we decide whether we will spend a lot of resources to save a few people? Do we apply the ratio of expenditure over dollars as our main priority. Some non-conventional treatments which cannot be scientifically proven such as chiropractic treatment for chronic pain could still be much more cost effective in achieving patient satisfaction for some patients while others will reject it outright. Recently McAllen, Texas received a lot of attention in the media for being the second most expensive place for Medicare expenditures in the country. The number of doctors both primary care and specialist there per capita is one of the lowest in the country. Visit a doctor's office there and one will always find a packed waiting room with many anxious family members accompanying the patient. These physicians are most reimbursed for the number of patients seen not by the amount of time they spend with each patient and practice in area of country where juries routinely award millions of dollars and almost never find for the defendant. Contrast this to Europe where complaints about medical practices are screened by an impartial medical board that only pass on the case to the court system if a significant deviation from the national defined guideline is clearly determined to be evident. Before America can move forward on real health reform, we must first have a government that clearly declares we are a society with limited resources. We must go beyond defining quality of health care as just a statistical entity and understand that the patient-health care system interaction is about more than just being a fix it shop. An important part of our society that allows one to come to terms with the inevitable hearkening of aging and mortality, the spiritual peace brought by religion, should play a more prominent role in health care especially for those with untreatable conditions or in the last few months of life.


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Dr. Tony Magana -- Bio and Archives

Dr. Tony Magana was raised in McAllen Texas, attended Texas A&M;University, and holds a doctorate from Harvard University. He has served in the United States Army Reserve. He is a member of the National Association of Hispanic Journalists.


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