Supporting medicine and its finest practitioners
The response to the Alexandria shooting reveals the kind of health care system we must build
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.