No Care and Rot

Phil's picture
Submitted by Phil on Thu, 2007-08-23 09:21

No Care and Rot

Ayn Rand's view on interlinking chains of concepts starting at the bedrock of sensory perception and marching upward with one logical step leading irrefutably to the next is marvelous. Reason and logic are the guides that allow Man to safely scale those lofty abstract outer reaches of human knowledge.

So it is only appropriate to start at the beginning, at that redoubtable bedrock of sensory experience. All creatures value life. More specifically they value their own lives and the lives of their offspring. They will do most anything and everything in their power to preserve it.

Man is no exception. It follows that if his life is valued then so to should the state of his health and those factors that promote and sustain it.

The practice of medicine is of course exactly that, the promotion of health life and wellbeing. It is an ancient and honorable profession. In the last hundred years the science and practice of medicine has changed almost beyond recognition. We now have the ability to heal in ways our forefathers never evened dreamed of.

The great irony of health care, at least in New Zealand, is the gap between what can be done for Man's health and what is actually done. It is a gap that has never been greater. Thousands languish on waiting lists for both assessment and surgery. They suffer and die waiting for treatment of a host of conditions that can easily be cured or at least ameliorated. Many thousands more lie bureaucratically hidden, waiting to get on the waiting lists. The official name for their dumping ground is "care and review". It is more aptly called "no care and rot".

It becomes all the stranger if one considers that as a nation we have never been so wealthy, our standard of living never so high, that our property markets have boomed for an entire generation, that we have not directly experienced a major war in decades.

In the final analysis our economy is predominately driven by the commodities market and globally the prices of beef and lamb have never been so good. The World wants what we have and has been paying a premium price for it.

So why is our public health system failing so comprehensively (The authors last 3 out of 6 public surgical lists have been cancelled due to lack of theatre personnel and has just completed one list only to learn the next will be cancelled as well)?

We have the desire ability and money to do so much better.

The answer in essence is state driven enterprises seldom perform well. They suffer from the separation of profit from performance. Without that essential feedback loop all sorts of inefficiencies and anomalies accumulate.

These accumulations are never so apparent than with the costly metastasis of medical management. Armies of short term hospital managers abound. They hold meetings, collate data, draw graphs, construct protocols and both speak and write in undefined acronyms. They promote so rapidly from any given position that they can never be held accountable for or knowledgeable of, in fact anything. Perhaps their most disturbing activity is their ability to bureaucratically mate spawning ever more swarming hoards.

Our health system needs that feedback loop linking performance to profit closed. Only then would the system begin to innovate and become efficient.

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A free American

Phil's picture

Health system?
I am not bashing the States. I always enjoying visiting the place and their conferences are just amazing. Hell it was Dr Kelman an American who invented Phacoemulsification cataract extraction the dominant technique in the first world.
I also lay no claim to any deep insight into anything American. It's just not on my radar.

But I have seen hints of unfortunate State and Legal restrictions on American medical practice. In 2004 I went to the American Academy meeting in New Orleans. Great meeting and it was a great city to visit.
One of the seminars I attended was on cataract surgery given ostensibly by two of their top cataract surgeons who were going to explain their latest techniques.

Boy was I excited and ready to have my socks blown off.

I could not believe it. They talked about this great new substance "Vision Blue" and how it had revolutionized surgery on advanced cataracts. They went on to say it was not FDA approved and how they smuggled in the boots of their cars from Mexico. The crowded room of surgeons were spellbound.

As a student surgeon I had routine been using the stuff in good old NZ 7 years previously!

When I did my tour of duty in Old Blighty it was standard practise as well.

I don't know a flying fig about the FDA but they sure dropped the ball with Vision Blue. What I can say is Vision blue is safe as houses, hugely beneficial in selected cases and used around the first world for the best part of decade before America. I have no idea if it is legal there even now.

Another example was give to me by a friend and colleague just out from the States doing a locum at our hospital. Great guy and solid Ophthalmologist. Practiced there for over 30 years. He marveled at our Cataract audit meeting(where we all present our surgical outcomes and complications etc). Its a universally beneficial meeting. A wonderful opportunity to track you performance, give and receive tips. To my knowledge all surgical specialties do this process in NZ. Open discussion and evaluation of objective measures of performance.

He marveled not at our outcomes(which were pretty dammed fine by the way based on international published data) but that we had the freedom of speech to have such a meeting at all.
This guy said "We never audit our work anymore. The lawyers killed M and M meetings."(mortality and morbidity) It turns out these closed door meetings were just fodder for more legal persecution of Drs by their ambulance chasers. The whole thing evidentially died about 10 years ago this included such processes their education of trainee surgeons.
They are literally too scared to measure how good or bad they are amongst their peers.

So much for free speech!

What a crying shame.

I agree...

Gigi P Morton's picture

No way is our system a free market if medicare/medicaid exist or the federal government orders that everyone must have medical insurance.


Matty Orchard's picture

I can't stand it when people call the American system a free market.

Stifling Regulation

Stifling regulation hampers the American system, starting with the third party payer system. True freedom in health care is hard to find these days.


You mean...

Emma Kathryn's picture

Like the American health care system?

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