UNIVERSAL HEALTHCARE

As an ER physician, the concept of universal health care is appealing, but is it feasible? One of the several reasons why health care costs so much is due to scores of people, especially at the university/teaching hospital level, lacking coverage. Obviously there will continue to be a dilemma regarding the treatment of illegal immigrants, but will universal coverage bring down health care costs? I don't know.


Please give me your comments on this topic. Remember, it does not matter if a person has insurance or not, or is a legal citizen or not, I have to supply the same level of care to that individual regardless since I'm an emergency physician and required to do so by law.

THE CHIROPRACTIC DEBATE

After reading the comments left by several proponents of chiropractic medicine and looking further into the curriculum and extent of the chiropractic scope, I have concluded several things for myself as a one practitioner of medicine.

I am, in the large medical realm, one practitioner. It would be purely arrogant and ignorant for me to believe that all answers to human suffering are found in the form of medical care I practice. Medical doctors have proven time and time again that we are not perfect and err as often as any other human. Unfortunately, we are in a profession where such errors may lead to bad outcomes or death. For a medical doctor to "look down" upon other medical practitioners would be egotistical and narrow-minded.

The field of medicine has a united goal to treat the patient and not do harm or be neglectful. Western medicine cannot fix everything, it may not fix many things. Patients deserve options to medical care. If one form of medical care does not work, they are fully entitled to seek other forms of treatment. With this said, if a patient has a surgical issue, they need surgery. If a patient who has cancer requiring resection (or other surgical ailment) opts to forgo surgery and seeks alternative treatments instead, that patient has a right to decide that for themselves despite what any medical professional believes. As long as patients are educated about the ailment, told of the options, and are of sound mind, they can decide their own fate...even if it will likely lead to death as long as that is known to them.

Osteopathy, physical therapy, alternative medicine and yes even chiropractic all have a place/role in treating patients. For one health care worker to speak unfavorably about one or the other is doing that profession a disservice. We need to be a united heath care team. From my own experience and ignorance, I can see how easy it is to fall into the trap of feeling threatened or distrust about another medical field.

After all this has been addressed, I will make a two closing comments. The general public has no clue what the realm of medicine entails. From fields of practice to tests to imaging to diagnoses to treatment options, the lay public is completely ignorant. Unfortunately, people think that if you call yourself "doctor" you went to medical school. The title of doctor has lost its uniqueness and magnitude amongst the public. Most people do not know the difference between PhD, PharmD, PA, DO, DC, DPT, DDT, MD, or even doctor of podiatry. Here's what I'm getting at, those that seek help in these different fields of practice should be informed about who they are seeing and their true scope of practice. Personally, I have no problem if my mother goes to see a chiropractor; however, if she believes that the chiropractor can treat/cure certain medical issues that require medications or even surgery because the chiropractor is a "doctor" that is entirely false and potentially damaging. People should know the scope of practice and capabilities of the medical professional they are seeing. Furthermore, we as medical professionals should be forthcoming with our limitations as practitioners.

Lastly, any medical professional using chest or abdominal xrays should not only be trained in their reading of the images but also have radiological oversight. Yes, dentists get xrays of the teeth, but they are very limited and usually just show the teeth. From what I know at this point, chiropractic medicine gets images of the thoracic and lumbar spine. These images likely also show both the chest (with thoracic) and the abdomen (with lumbar). My concern is this, is there professional radiological oversight regarding the chest and abdomen with these images? I have learned from recent discussions on this blog and elsewhere that there are chiropractors trained in radiology reading, but I have not been told if they also have been trained in reading body xrays.

My final comment...finally.
I make errors in my practice almost on a daily basis. Most are very small errors that are corrected immediately and will never cause any harm. Unfortunately, all medical doctors in my field (emergency medicine) could say the same thing. If they deny making errors, it simply means they don't know about their mistakes or they're kidding themselves. Also, every medical doctor went through residency, this virtually guarantees they've made errors. For one of us in any field of medicine to attempt to justify why our field is more superior is purely egocentric and false. Thinking about my prior comments regarding the debate between chiropractics and traditional medical practice, it is easy to see the somewhat separatist viewpoint many medical professionals take. The goal of medicine is to treat the patient, and treatment can come in many forms.

ON WAR

"I know not with what weapons World War III will be fought, but World War IV will be fought with sticks and stones."

- Albert Einstein

PLEASURE READING

I will not recommend any medical books here because I strongly believe that we should try to learn about other realms of life instead of what we are already accustomed to. The following is in no particular order.

1. 1984 - George Orwell
2. The Iron Heel - Jack London
3. Oh Pure and Radiant Heart - Lydia Millet
4. The Call of the Wild - Jack London
5. Walden - Henry Thoreau
6. Solitude: A return to the self - Anthony Storr
7. The Curve of Binding Energy - John McPhee
8. Essays on Nature - Edward Hoagland
9. Anything by Arthur C. Clarke - wonderful science fiction
10. The Stand - Stephen King
11. Huckelberry Finn - Mark Twain
12. SAS survival handbook - John Wiseman

BETTER

For you physicians or practitioners reading this, which is probably numbering about three total, there is a good book out there written by a general surgeon and focuses on ways we can improve our performance in many aspects of care.

It is called "Better" and was written by Atul Gawande, an general surgeon in Boston. Besides being an excellent writer, he adresses some great topics concerning health care. From hand washing to why a long time orthopedic surgeon turned to malpractice law and now sues doctors. Truly inspiring.

For those of you who are not into an easy 2 day read, he summarizes some advice at the end about how one goes about becoming a "positive deviant" (speaking of a bell curve). His points are as follows:

1) Learn something about your patients and co-workers. Ask them one simple question about themselves and you'll be surprised at what you may learn.

2) Don't complain. It is a waste of your time and the time of those listening to you.

3) Count something. By being a scientist it will likely lead to a postitive change.

4) Write something. I can attest to this one myself...it helps make sense in a world of confusion. By writing this blog, I'd like to think I've learned something and become less ignorant.

5) Change. Be willing to adapt and try new things. We have only come this far b/c someone what willing to go out on a limb.

UPDATE ON LIFE

Since my complete lack of posts to this site over many months, there have been changes both in my life and medical practice. Some have changed the ways in which I view some issues. Yes, the experiences one deals with on a daily basis do in fact mold the impressions we form of society and affect the way look at and treat others.

During my sabbatical away from this blog I had a son. Not to sound cliché, but he is the light of my life. Funny how he is the one to need everything literally spoon fed to him and helped at every step of the way, yet I am the one who feels empty when away from him. Having a child, changes a person. I will always be a cynic at heart, but now I have to have hope for the future. No longer can I watch the evening news simply b/c of the violence painted over nearly every story.

Another affect a child can have on a parent, which as sad as it may be does not happen sometimes, is that the parent suddenly wants to be a better person. You tend to let go of the mundane and minor squabbles of your past and focus more on the positive, or better yet, what could be.

With that said, I will state a few things that, after reading most of the entries in this blog, may surprise you...

First, I have received and posted several replies about the chiropractic issue, which I have addressed in the past. After reading them and considering the topic further, I wanted to address some thoughts again. Patients deserve the best care possible. Whether they are helped by medical, chiropractic, or other means is irrelevant. What matters is that patients get better or are helped in some way THEY deem appropriate. Obviously, if someone's having a heart attack, they need a hospital, not an adjustment. Along those same lines, aggressive medical care is not always appropriate and other means should be sought. My chiropractic colleagues have just as much a right to try and help patients as I do. Whether the patient chooses an MD, DO, DC, PT, or any other two-letter degree is their prerogative. It is not my place to criticize any profession when I make mistakes on a daily basis. Medicine is more an art than a science, and from college I can tell you I'm no artist.

Second, we as a society are in distress. I have no idea as the state of the rest of the world but it appears that in this country we're in trouble. Children are becoming parents by the age of 16, and worse yet, given their total lack of knowledge or fear of birth defects, they smoke, drink, and do drugs during pregnancy. The elderly, who are revered and looked upon as the highest tier in some cultures, are left for dead in nursing homes - rotting away for years at the expense of the American tax payer. (I only bring this one up b/c I really worry about what will happen to my parents with age.) The middle class, those that make up the majority in the country, are carrying the brunt of the financial problem. They work and make a wage, yet do not qualify for certain health care aid programs and still have to save for retirement and their children’s' college years. Our politicians are so two-sided and divided that this country will likely never feel as a united front, despite whatever terrorist act takes place next.

We are a nation of aggressive, back-stabbing, cheating, selfish, undermining, materialistic gluttons who are spiraling down. I can only say these things because I too am part of society.

I am afraid for our children.