Sup­port­ing medicine and its finest prac­ti­tion­ers

The re­sponse to the Alexan­dria shoot­ing re­veals the kind of health care sys­tem we must build

The Washington Times Daily - - COMMENTARY - By Marc Siegel

Treat­ing emer­gen­cies isn’t your in­sur­ance talk­ing. It’s doc­tor­ing. It’s nurs­ing. It’s med­i­cal tech­nol­ogy. It’s your in­fected gall­blad­der reach­ing the point of burst­ing and the top sur­geon who knows the la­paro­scope as well as any­one alive rush­ing in to do the late night pro­ce­dure him­self. You can’t prove that a ju­nior at­tend­ing wouldn’t do just as well, but you can feel it in your bones, in your belly, feel it where the wound is heal­ing so well two days later as you gaze dumb­struck at the photo of the an­gry raw or­gan that was scope-sucked from your body.

The best of emer­gency health care is also what we saw rep­re­sented on the television screen last week, as top doc­tors came for­ward at press con­fer­ences to de­scribe their craft, their art, a re­minder that the health in­sur­ance fu­ture we’ve all been de­bat­ing lacks real flesh on its bones. Re­mem­ber, an in­sur­ance com­pany can’t man­u­fac­ture or guar­an­tee the pro­fes­sion­al­ism or ded­i­ca­tion or skill of one Dr.

Jack Sava, head of trauma at Meds­tar Wash­ing­ton, who di­rected the in­cred­i­ble life­sav­ing process for House Whip Steven Scalise. Mr. Scalise’s treat­ment in­volved the com­plex process of re­pair­ing dam­aged blood ves­sels and pelvic or­gans (such as blad­der, bowel, kid­ney), torn asun­der by the wide track­ing frag­ments of a speed­ing bul­let.

The pelvis is rich with blood sup­ply, and the mir­a­cle med­i­cal crew man­aged to pour blood in faster than it was pour­ing out, no small feat while man­ag­ing to pre­serve es­sen­tial blood flow to the brain. There will be a long re­hab process ahead with pain man­age­ment and in­fec­tion con­trol (he will likely be at risk for wound, bowel and blad­der in­fec­tions as well as pneu­mo­nia) and more sur­gi­cal re­pair. Top doc­tors and nurses will be needed through­out the heal­ing process.

Un­for­tu­nately, no one-size-fits-all health in­sur­ance can guar­an­tee that the best sur­gi­cal and re­hab teams will al­ways be avail­able in sim­i­lar lower-pro­file cases at less prom­i­nent trauma cen­ters.

And then there was the team of doc­tors at the Univer­sity of Cincin­nati Med­i­cal Cen­ter who re­ceived pa­tient and vic­tim Otto Warm­bier from North Korea. The team was led by Dr. Daniel Kanter, med­i­cal di­rec­tor of the neu­ro­science in­ten­sive care unit. At a press con­fer­ence last Thurs­day he re­vealed that poor Otto had suf­fered se­vere brain dam­age from ap­par­ent stop­page of breath­ing and car­diac ar­rest likely from some­thing he’d been given rather than from head trauma and — ac­cord­ing to neu­ro­log­i­cal test­ing — cer­tainly not from bot­u­lism as the North Kore­ans had claimed.

We learned all over again that your eyes can be open but you can still be un­re­spon­sive, and the longer this veg­e­ta­tive state per­sists the less likely you will ever awaken. Otto Warm­bier sadly died this past week.

Like Dr. Sava, Dr. Kanter too led an im­pres­sive group of doc­tors who might have made a dif­fer­ence if they weren’t trag­i­cally re­duced to an af­ter-the-fact Sher­lock Holme­sian anal­y­sis.

In both cases, view­ers could look to the screen and won­der “would I re­ceive such top flight treat­ment if it were me? Would I be able to get in to see a doc­tor like this if I have a sud­den emer­gency?”

The an­swer for the time be­ing, more of­ten than not, is still yes. But what of the fu­ture? “Will med­i­cal school be af­ford­able and will re­im­burse­ments be suf­fi­cient to keep in­cred­i­ble doc­tors like this from quit­ting?” My pa­tients are ask­ing and I don’t have a clear an­swer. The heart of a healer col­lides with the lim­i­ta­tions of an evolv­ing or de­volv­ing man­age­ment sys­tem.

Many years ago I was hitch­hik­ing through Europe and was picked up by a ca­su­ally dressed agree­able man driv­ing an old VW minivan. Af­ter much con­ver­sa­tion he fi­nally told me that he was a fa­mous on­col­o­gist who was paid the equiv­a­lent of $60,000 a year (in the 1980s) to care for very sick pa­tients. He openly ad­mit­ted that the best thing about his job was the time off it af­forded him to travel.

We don’t need or shouldn’t want that sober re­al­ity here. Un­for­tu­nately, both the Af­ford­able Care Act and its pro­posed re­place­ment the Amer­i­can Health Care Act — in its cur­rent form — rely on an ex­panded in­sur­ance model which jeop­ar­dizes the role of doc­tors. We are al­ready strug­gling with a grow­ing doc­tor and nurse short­age, ex­cess com­puter doc­u­men­ta­tion and a ris­ing fear of mal­prac­tice as we work to mas­ter the lat­est tech­nol­ogy. The sad day may come in the near fu­ture when you look to the television screen and no longer find a con­sum­mate physi­cian with the prow­ess of a Dr. Sava. We are build­ing more “planes” with­out con­sid­er­ing who is go­ing to pilot them.

IL­LUS­TRA­TION BY HUNTER

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