Friday, March 5, 2010

Excitement and Depression in the Potential for Change in Health Care

I have been reluctant to write about health care recently. My 11-month-old son will be going in for major brain surgery in April, and my psychological tendency is to put it out of my mind. I’d rather hear him in the mornings as he plays in his crib. I want to meditate on his wonder of just being alive and playing with his newest discovery, his voice. He is my proof for the truth of the gospel and Jesus’ love for us. Yet, I must find the strength to speak for the truth again. I must change for his sake and deal with reality.

Through the whole ordeal with my son, I have come in close contact with our medical system, both the good and the bad. I have added my voice to the need to reform the way we do health care. Our system’s recipe, several slabs of dysfunction flavored with a pound of greed, has led to growing costs and a competitive disadvantage worldwide. It can lead to our downfall. More than the numbers, we have to remember that behind the numbers are real humans like my son. Literally, it is a matter of life and death for thousands of people.

The proposed changes are a start. Yet they fail to address some of the systemic problems: pay per service, the inefficient payment system, the lack of collaborative medicine. The irony is that we do have model systems of health care that work: the Mayo Clinic, Johns Hopkins, and the hospital that is treating my son, Seattle Children’s Hospital. These institutions are models to follow, and sadly, models all too rare in the United States.

Now, as we are coming to the end of the health-care debate, and I think some bill will be passed, I hope we are not stopped by a wall of seeming success. None of the reforms proposed attack the systemic problems. Health-care costs will continue to drag American business behind other countries. The problem we have yet to address is how best to deliver health care. We have to change how we deliver care.

Change, we have to acknowledge, is hard, but it has to be done. Atul Gawande wrote a famous essay on how hard it was to get checklists into hospitals’ ICUs, even though they cost little and are shown to save lives. Gawande’e article both excites and depresses — excites in how a simple change saved lives, and depresses in how those changes were and are resisted. He quotes Dr. Peter Pronovost on why his discovery of using checklists was not adopted more. The quote reveals our psychological tendencies and the problems we face in repenting from our ways:

The fundamental problem with the quality of American medicine is that we’ve failed to view delivery of health care as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is insuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective it’s outrageous.

Whatever emerges out of the next round of reforms, we must continue to push for more reforms. My son’s generation is counting on us.

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