Houston, we have a problem…

Ok, let’s talk about health care. I have said for years that the current system can’t last too much longer. Doctors are refusing to see any more Medicare or Medicaid patients, because reimbursement is low (or in some cases, as I have experienced in the past…nonexistent).

Insurance coverage as it is currently administered offers no responsibility to the patient to make reasonable choices:  a sniffle?  “Doc, I need the strongest antibiotic you can give me, because nothing else ever works…”

I have been seeing Mr. R.:  esophageal cancer with metastases to liver and bone, throat completely closed with tumor and held open by 2 metal stents.  As a recovering alcoholic, he also has end stage cirrhosis:  his abdomen is as distended as an 8 month pregnancy, filled with fluid his liver can’t process.  He has lost 60 pounds in the last 3 months. He has failed chemo, radiation and surgery-the tumor continues to grow…and has again completely occluded his esophagus beyond the stents. Because his liver can no longer eliminate toxins, he is confused, lethargic and often combative.

His wife insists that “everything” be done:  full code, referral for liver transplant, surgery to again open his throat, TPN (food by vein at about $1000/day)….

…and because there is certainly some lawyer waiting in the wings to back up her demand, the medical community complies. In these, the last 2-3 months of his life, we will spend nearly $100,000 in futile care.

Multiply Mr. R. by thousands of patients nationwide.

Add to that the recent furor over changed recommendations regarding frequency of pap smears and mammograms…

…and it is clear that though congress may change the health care delivery system, nothing will change until there is a fundamental change in the understanding of what is reasonable care.