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Patients, physicians need to both give up some control

October 30, 2009
Dr. Lyle Best

I greatly appreciated Dr. McIntyre's comments in the Sept. 12 issue of this paper about the current healthcare "debate".

He has selflessly contributed more to the provision of high quality, affordable healthcare in this region than anyone I know. While I agree with many of the points he made, I have to take issue with a couple.

It was asserted that no one in this country suffers from lack of healthcare, "if they want it". The implication is that a person without insurance can always go to an emergency department, where (in most facilities) they can't be turned away.

This misleading assurance is often repeated; but is illogical in a number of aspects. First, please explain how a person could possibly access typical preventive services in an ER? How do you screen for high blood pressure among people who are otherwise feeling well; how do you get a screening for Pap smear, mammography or colonoscopy? It definitely won't happen by dropping by the ER on a quiet night. Furthermore, just because they can't turn you away from the ER doesn't mean that the facility can't hold you accountable for paying, send collection agencies after you, garnish your wages, etc. All of this results in much medical care provided in a last minute, salvage-mode, and in the most costly, chaotic environment available. Mention was also made that perhaps a quarter of the 47 million Americans without health insurance are illegal aliens. It is clear that we are too embarrassed to have these children dying of meningitis, and their parents bleeding to death on the curb outside our shining hospitals, so why do we deny care in all but the most costly, ineffective emergency departments? Denying healthcare is not the answer to our immigration problems.

Dr. McIntyre's points one, three, four and seven relate to the high cost of often futile care and procedures of dubious benefit. We have let Hollywood and various "leaders" sell the idea that the opinions of "assertive" parents, "informed medical consumers" and even completely unrelated bystanders (think Terry Schiavo) are of equal validity and can trump qualified medical opinion. Many people offer the fantasy that medical decisions are made simply between the doctor and patient; but in our commercialized medical system it is a rare, courageous and often poorer physician that goes directly against the wishes of the patient who is determined to have surgery, to take an antibiotic, or is threatening to sue.

This is not to deny the benefit of real patient education; but most of this "education" is now provided by self-serving entrepreneurs. Few will admit this publicly, but part of the answer to our problems is for patients, physicians and the population to give up some of the autonomy they now "enjoy" in our healthcare marketplace.

Best is a rural Rolette resident



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