Ethics in Healthcare

I have a very unique and privileged position in the current healthcare environment. Not only am I blessed to be a clinician (see patients), I have the additional honor of being involved in the administrative aspect of medicine as well. Because of my unique position, I hold many committee memberships. One of those positions added recently was for my hospital's ethics committee.

One topic discussed in most committees is the upcoming flu season. People don't realize the planning that hospitals endure in preparation for a possible pandemic. The need for intensive care unit beds, ventilators, additional staffing requirements, etc., are discussed as much as the joint chiefs of staff may discuss their available resources for an upcoming defensive or offensive deployment.

Our recent discussion concerned the need for personnel in case of a disaster, including a flu pandemic (we are due for a true pandemic-not a media generated hysterical fake pandemic, but a real one). Our discussion centered on the response of the hospital's staff, nursing, ancillary and even physicians. I was always under the impression that we always show up for work, regardless of our own states of health. In one of my earlier posts I even vented when I had to get up during a "snow emergency" and go to work when everyone else, including civil servant emergency personnel, stayed at home.

Our discussion turned into a real eye-opener for me. My take on the whole issue was that if my family were safe and didn't need my immediate attention, I would be at the hospital caring for patients and staff. I've always wanted everyone who knows me to think of me as a regular person first, then as a physician. Being a physician was always what I did, not who I was. After our discussion, I doubt there are many people, much less physicians and healthcare personnel, who will be there when we need them.

Most members of the committee (all had been members long before me and had this discussion before) had a sense that a significant percentage of personnel would stay at home in the event of a disaster (tornado, flood, terrorist attack, flu pandemic, etc.). They have even gone so far as to plan for daycare services for employees to encourage them to come to the hospital.

The trend of non response is a direct reflection of the younger, more selfish, generation. Physicians my age and older would respond without hesitation. We are also the physicians who used to work 80-100 hours per week as residents learning to take care of patients. We were overwhelmed on a daily basis and learned to deal with the stress that comes with it. We learned to triage patients over the phone because we had seen SO MANY patients during our short careers that it became second nature to us. Common things occur commonly, and we saw many of them. Because of the large volume of patients, we also got to see many of the uncommon things first hand, not hear about them from someone else the next day. This hard work gave all of us the work ethic that most people attribute to their older physicians.

The newer , younger, physicians are the ones who, as residents, had mandated limited working hours, scheduled time off and limits on the number of patients they could care for. More technology and fewer patients means less "hands on" direct patient care and experience. These physicians have become so accustomed to the reduced working hours that they are all looking for 40 hour per week jobs, 9-5, no call and no weekends. Boy, wouldn't that be nice?? And you know what? There is such a shortage of doctors in some areas, that some of these physicians are getting exactly what they want.

The work ethic of your parent's doc, or maybe your own, is a thing of the past and will be dead and completely gone when I and mine retire. So when the pandemics or disasters hit, don't be surprised if that new young doc who just graduated and moved into your neighborhood isn't huddled at home with you.


Doc B

My opinion is free.
Advice is worth exactly what you pay for it.

Our Tax Dollars at Work?

Sorry, but today no healthcare related rant. Too much other juicy stuff going on that have made healthcare, the once hot topic, take a backseat. The most recent issues are certainly related around the economy and the resultant collapse of the credit markets and the banking system. Mortgage backed securities have become the junk bonds of the 21st century, much like Michael Milliken of the 1980's.

The governement's (Bush) response to the crisis was at first to ignore that there was a problem. Then, when it got smacked in the face with it, a 700 Billion dollar bailout with taxpayer money to stem the fear of a total collapse of the US markets; the likes of which hadn't been seen for decades, or maybe even since the great depression. An economy in shambles. National debt at it's highest ever and a deficit that will be an estimated 700 Billion to 1 Trillion dollars next year. What an inheritance for the the next president to assume and a great gift to leave our children and grandchildren.

Among all of this is the presidential election. The candidates are making their final push to sway and attract voters. TV, radio and print adds are flying with wanton abandon. Unsolicited telephone calls invade my home, and cell phone, on an almost daily basis. Emails come daily filling up my inbox with garbage I don't want to see or read. How do they pay for all of this?

Just out in the last few days are the latest figures for both candidates' fundraising efforts over the past several weeks. Obama, who opted out of the taxpayer funded campaign program, has raised nearly 150 Million dollars from donations for the Sep/Oct period and along with party funding, has nearly 200 Million dollars at his disposal leading up to the election. McCain, on the other hand, opted for public taxpayer money and is limited to 84 Million from now through election day. Both candidates still have their respective parties funding some of their advertising. Obama's total raised by his campaign for this election totals more than 600 Million, while McCain raised just 240 Million.

With the kind of money these guys are raising, I think that to use public funds, when it could be used in other areas, is fiscally irresponsible. I know that camapign finance reform was designed to reduce the campaign contributions from large influential contributors and therefore reduce fraud and corruption, but they have gone from one extreme to another. And, who really thinks that our politicians are any less corrupt than they used to be?

Considering the amount of money raised by each party, the disparity in fundraising between Obama and McCain, how can anyone say the election wasn't "bought"? Obama raised so much money after the convention, he was able to buy up every minute of available airtime on all the networks prior to the election. Even if McCain had raised more money, he would have had no real effective outlets where he could be purchasing advertising time. No one will ever doubt that Obama ran a very military precise campaign but without funds it never would have happened. Elections can still be bought despite campaign reforms.

I believe it should not be up to the taxpayers to fund the presidential elections. The individual candidates should be responsible for their own funding. But, that funding should not be a result of a popularity contest or the financial capability of their constituency. The federal governement's role in this process should be one of oversight. Each candidate must have access to the same resources as the other. A cap on the amount spent should be instituted so that one candididate does not simply outspend or "out advertise" their opponent. Equal spending would therefore make the candidates concentrate on the content of their messages instead of the volume of their messages. We all have the same feeling this year; just get it over with.

This year's election will be determined by the amount of money spent on the election. It is yet to be seen if that turns out to be the right choice.

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.

Aletrnative Healthcare Proposal-AMA Style

Finally, something else to talk about than the same 'ol Republican/Democratic proposals. The American Medical Association has expanded it's original recommendations for universal healthcare to the current "three pillar" approach. Overall, conceptually, it seems less painful than some of the political proposals, but has some not so pleasing aspects itself. You can read a synopsis of the plan here.

The AMA's three pillar approach is; 1. helping people buy health insurance through tax credits or vouchers; 2 choice for individuals and families in what health plan to join; 3 regulating markets and protecting high-risk patients. I don't think anyone has an issue with numbers two and three of the three pillared approach. What is somewhat different is their proposal for how to pay for the tax credits and/or vouchers.

Their idea is to eliminate or markedly reduce the tax benefit that employers and or employees receive by not having the employer based healthcare benefits taxed. Most employers who provide health insurance are able to deduct the cost of insurance as a business expense, and therefore, pay no tax on them. Employees are not usually taxed for those benefits either. McCain's plan opted to tax the employers. The AMA wants to tax the employees.

The AMA idea is to tax all, or a portion down to a minimum allowable, of the healthcare benefits to recoup the estimated 125 Billion in lost tax revenue. Those additional taxes would be used to pay for, or subsidize, low income or uninsured persons though tax credits or vouchers. The credits or vouchers HAVE to be used for the purchase of health care benefits. In essence, it amounts to another entitlement program through a redistribution of "wealth".

Their thinking is that the highest income earners who receive the same employer-based health insurance benefit, receive the largest tax break since they are in a higher tax bracket. True, but only if those benefits are universally taxed for all recipients. They are not at the present time. This amounts to the same type of taxation and redistribution of wealth that occurs now. People of higher incomes are taxed at a higher rate. Those dollars are used to pay for the government funded entitlement programs that the higher income individuals will NEVER benefit from.

This is not a "government funded" or subsidized program. It is the creation of a new tax and the subsidy is coming from, on a percentage basis, the same taxpayers who are already providing a larger percentage of their income for entitlement programs. That is a perfect definition of a distribution of wealth.

I am all for a form of universal healthcare that takes care of all of us, including those who contribute no taxes into the government coffers. But, I do not think that the first place to look is in the pocket of the populous who are already paying their fair share of taxes. Why not look to the greed of the insurance companies or the horrible inefficiency and waste of government programs? Pay for it with the SAVINGS that can be wrung out of the current failed system, not by creating ANOTHER tax.

I'm tired of working the first 6 months of every year just to pay taxes. How about you?

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.