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Health Care Reform Debate from a Cardiologist's Perspective

Dr. Kirk Laman: Wholehearted Cardiologist Health Pro August 07, 2009
  • Life is full of hard choices. Nowhere is this clearer than in world of medical care.Now in particular, we are all faced with hard choices.  President Obama has proposed a major overhaul of our health care system.  Just this past Friday, Congress announced plans for a new health care plan. T...

13 Comments
  • probiotics
    Dec. 26, 2011

    Hey there admin, just wanted to leave a quick comment to say that I liked your post.

  • Anonymous
    Lucy Sorlucco
    Aug. 13, 2009

    Thank you Dr. Laman, for you thoughful, reasoned request for a vital discussion.  The recent misinformation that has been decimated to the public has especially frightened Senior Citizens with spectors of "rationing" and "Death Panels".  My mother is 80 years old and has survived successful Aortic Valve Replacement.  We discussed what...

    RHMLucky777

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    Thank you Dr. Laman, for you thoughful, reasoned request for a vital discussion.  The recent misinformation that has been decimated to the public has especially frightened Senior Citizens with spectors of "rationing" and "Death Panels".  My mother is 80 years old and has survived successful Aortic Valve Replacement.  We discussed what she would want prior to the surgery and I became her proxy.  Gratefully, she is thriving and living independently almost two years later.  These decisions are important and are being made now by thoughtful people and can be altered, as they see fit.  Medicare IS Government run Health Insurance!  It seems the predominant sector inflamed by the Health Care Reform proposals including a Public Option...is the very group enrolled in one!

     

    Sincerely,

     

    Lucy Sorlucco 

    • Anonymous
      EyeDoc
      Aug. 13, 2009

      One quick comment -

       

      Medicare is a government program paid for by our payroll taxes.  It is run by many private insurance companies and overseen by the federal government.  It does involve to some extent rationing and many treatments and drugs that are available to the general public may not be available to Medicare recepients. 

       

      ...
      RHMLucky777
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      One quick comment -

       

      Medicare is a government program paid for by our payroll taxes.  It is run by many private insurance companies and overseen by the federal government.  It does involve to some extent rationing and many treatments and drugs that are available to the general public may not be available to Medicare recepients. 

       

      What many people are concerned about (not just Medicare patients) are a number of statements by President Obama as well as a number of members of Congress that seem to indicate that there will be rationing, that we will consider quality of life before making therapeutic decisions and that the government will make a number of decisions that will have no appeal.  We have already done that in the criminal justice system where we have removed discretion from sentencing decisions.  That was done with best of intentions - it has not worked well. 

       

      So think for a moment if you will - about how you would like it if certain life and death decisions, certain treatment decisions could not be appealed.

       

      Let me give you one example that I can easily forsee - many patients with macular degeneration do not significantly improve after cataract surgery - at least by using routine tests that you are no doubt familiar with such as an eye chart.  But their quality of life is improved.  I can see in the not so distance future - in an attempt to save money (after all cataract surgery is the most frequently performed surgery in the US) - the single payer would say - that if you have macular degeneration - that they will not cover the cost of catarct surgery.

       

      In business this is called return on investment and I have sat on committees where we discussed just that topic.  So what do you think your vision is worth.    Well if I cant improve your vision to at least 20/40 so you can see well enough to drive a car - then maybe the return on investment on your surgery would not justify the cost and therefore would not be an option for you.  Sorry.  Case closed.

       

      Is that what you really want? 

    • Dr. Kirk Laman: Wholehearted Cardiologist
      Health Pro
      Aug. 18, 2009

      Thank you Lucy for your reply.

       

      Decisions are indeed difficult.  In many other health systems your mother would not have been offered Aortic Valve replacement at her age.  In America we don't currently limit care based on age. I have had many patients undergo cardiac surgery in their 80's and often the do quite well.

       

      I think we do need...

      RHMLucky777

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      Thank you Lucy for your reply.

       

      Decisions are indeed difficult.  In many other health systems your mother would not have been offered Aortic Valve replacement at her age.  In America we don't currently limit care based on age. I have had many patients undergo cardiac surgery in their 80's and often the do quite well.

       

      I think we do need an open dialogue of these issues.  I applaud you for being willing to express your opinion.

       

      thanks again.

       

      Dr. Kirk Laman

      www.drlaman.com

  • gray lady
    Aug. 13, 2009

    I agree that we need to have a national discussion about end of life care.  My 90 year old, 98 lb., Mother fell and broke her right hip and her right arm in June of this year.  Until this event, she lived alone and independently.  She had a living will and had clearly stated she wanted no extrodinary means of keeping her alive. ...

    RHMLucky777

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    I agree that we need to have a national discussion about end of life care.  My 90 year old, 98 lb., Mother fell and broke her right hip and her right arm in June of this year.  Until this event, she lived alone and independently.  She had a living will and had clearly stated she wanted no extrodinary means of keeping her alive.  She even listed in this will, NO Ventilator and NO Feeding tube.  However, when her her stomach did not begin functioning afer a few days, they put a tube down her throat to stop the vomiting.   Then, they began feeding interveinously.  They took her for X-rays of the abdomen daily and called in a stomach doctor.  To make a long story short, she lingered in pain, confusion and misery for three weeks.  During this 3 weeks, Cat scans were ordered, blood work was done daily, expenses continued to mount.  My Mother wanted to die.  She was ready to die.  But, no one ever gave us the opportunity to say enough; just let her die!  At one point I even asked how long could she live without the feeding and no one was willing to address that with me.  Yes, we need to have a serious discussion of end of life care.  It shouldn't just be about the bottom line, but about dying with dignity and as little suffering as possible.

    • retired RN
      Aug. 14, 2009
      what you describe is like what I went thru with my mother, EXCEPT she filled out a detailed description of what she DID NOT want done And signed over to me power to make these decisions for her ,if necessary..called Durable Power of attorney for healthcare..I confronted the 2 MDs in charge of her care..."she doesnot want this." I then signed her out of hospital,...
      RHMLucky777
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      what you describe is like what I went thru with my mother, EXCEPT she filled out a detailed description of what she DID NOT want done And signed over to me power to make these decisions for her ,if necessary..called Durable Power of attorney for healthcare..I confronted the 2 MDs in charge of her care..."she doesnot want this." I then signed her out of hospital, took her to my home and with the help of Hospice Nurses kept her comfortable until she passed away in her own bed a week later.... This show "discusions" BEFORE a situation arrises can circumvent many issues
    • Dr. Kirk Laman: Wholehearted Cardiologist
      Health Pro
      Aug. 18, 2009

      Thank you for your comment and information.  As a physician, I see both sides of this issue.  I see patients who make their wishes known to not prolong life, but then family members overide their wishes.  I also see physicians who won't bring up the idea of limiting treatment.

       

      I believe that discussions such as these are vital to helping...

      RHMLucky777

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      Thank you for your comment and information.  As a physician, I see both sides of this issue.  I see patients who make their wishes known to not prolong life, but then family members overide their wishes.  I also see physicians who won't bring up the idea of limiting treatment.

       

      I believe that discussions such as these are vital to helping to develop a public dialogue regarding these issues.

       

      Thanks again.

       

      Dr. Kirk Laman

      www.drlaman.com

       

       

       

  • HollyNicki
    Aug. 13, 2009

    Things like you described could be handled ahead of time by discussing with your family what your wishes are with regard to life support.

     

    My husband and I have discussed this with our children and other family members and they know that we do not want to live on life support and we have gone to a lawyer and got the proper papers drawn up so that our...

    RHMLucky777

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    Things like you described could be handled ahead of time by discussing with your family what your wishes are with regard to life support.

     

    My husband and I have discussed this with our children and other family members and they know that we do not want to live on life support and we have gone to a lawyer and got the proper papers drawn up so that our children will not have to make this decision for us.

    • gray lady
      Aug. 13, 2009

      Good for you!  But, read my statement on End of Life Care and you may be surprised to learn that even when you try to make your wishes known, there are still ways of prolonging your suffering and giving the health care professionals ways of increasing the bottom line.

    • Dr. Kirk Laman: Wholehearted Cardiologist
      Health Pro
      Aug. 18, 2009

      I think you are right.  One idea would be to make it manditory for every person who gets admitted to the hospital to give detailed instructions about their wishes for life support treatment.

       

      thanks for sharing.

       

      Dr. Kirk Laman

      www.drlaman.com

  • Anonymous
    Anonymous
    Aug. 13, 2009

    There are many who do not have insurance who are in no position to even make a choice as the family in your example.  We give handouts by the billions to people in other countries, so I don't understand why we are so reluctant to spend on our own people.  Point two.  I use to trust my family doctor.  But, I have strong evidence that supports...

    RHMLucky777

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    There are many who do not have insurance who are in no position to even make a choice as the family in your example.  We give handouts by the billions to people in other countries, so I don't understand why we are so reluctant to spend on our own people.  Point two.  I use to trust my family doctor.  But, I have strong evidence that supports my concern about being able to trust my primary physician under my HMO insurance.  I believe that it is a waste of time for me to seek help from my primary physician, who will tell me to eat more vegatables, but will do whatever it takes to keep me from an appointment with a specialist.  My primary physician is not to blame for my CAD, but she has delayed taking action when it was clearly time to do so on more than one occasion in my case.   May be it is too late, but at least the new adminsitration is moving out on health care when everyone else wants to continue to talk.  How many will die in the mean time. 

    • Anonymous
      EyeDoc
      Aug. 13, 2009

      Both Dr. Laman's comments and yours move me to write a comment and to give you some advice.

       

      First you comment that there are many who do not have insurance who are in no position to even make the choice - IS INCORRECT.  This woman or you for that matter would be entitled to receive the same care as was described in the article.  However the...

      RHMLucky777

      Read More

      Both Dr. Laman's comments and yours move me to write a comment and to give you some advice.

       

      First you comment that there are many who do not have insurance who are in no position to even make the choice - IS INCORRECT.  This woman or you for that matter would be entitled to receive the same care as was described in the article.  However the article does bring up a very difficult moral question that we as physician are faced with regularly.    And just maybe the government should be making those decisions - if you are 75 years old - and you have a heart attack - you dont get open heart surgery.  If you are 70 years old and you have a bad hip - you wont get a hip replacement.  If that is really what you want...then perhaps you really do want to have a single payer health care system.  But I think if you really knew the ramifications of what you are suggesting... and I think you do... then I think that you really don't.

       

      No system is perfect - no physician is perfect.  We all make mistakes - because as has been stated before - medicine is not a perfect science.  But we try (or at least most of us do). 

       

      As a physician who worked for many years in his own private practice, then became medical director for an HMO and then for 4 years worked with a national accrediting agency as well as for the federal government - I have seen and experienced a lot.

       

      It pains me to that that you think your physician is giving you substandard care and refuses to send you to a specialist. First I would suggest that you write your doctor a letter expressing exactly how you feel, why you feel that way and your concerns - and request that she take some time at the end of her day to sit down and talk with you about your concerns.

       

      If you are not satisfied with the result of the interview, then you have an obligation to file a complaint with the HMO and/or the state board of medical examiners in your state expressing your concerns and frustration along with documentation.  While the vast majority of physicians are caring and very much want to give the best care they can - there are a small percentage who should not be practicing medicine or who do not render the best or most appropriate care.  As a profession, we need to weed these doctors out - retrain them if possible or remove them from practicing medicine.

       

      I know there are many people for whatever reason who are dissatisfied with their care - even if it is the best care that they can be given.  There are many who because of watching television have come to believe that physicians are miracle workers and if they are not cured immediately - think their doctor or the system is at fault.  That just isnt the case - but I wont be able to convince you - nor will anyone else be able to.  Your views are your views... and as we have seen with many patients who believe in medical treatments that have been discredited - there is nothing I or any other person can do to convince your differently.

       

      Finally - we all want something for nothing... it has become I am afraid - the American way.  If I can get someone else to pay for something I need - then why not.  We have been for many reasons that would take too long to go into - led to believe that health care is a right - something that we should not have to pay for.  And that we should all be able to get Cadillac service for Yugo rates. 

       

      It just wont happen.  Sure some doctors make a lot of money, pharmaceutical companies make profits as do medical equipment manufacturers and hospitals.  Is that wrong?  Are there excesses in the system - yes there are - but this is not a perfect world. 

       

      Do I think the system needs improving - absolutely - but the changes need to be evolutionary - not revolutionary.  Whether you believe it or not - this system is not broken - but it does need tweaking.

       

      Hoewever what is being currently proposed - will not correct the problems you are talking about - if anything it will make them worse.  Just for the record:

       

      1.  It will not decrease costs

      2.  It will not significantly improve the quality of life

      3.  It will not improve the quality of care for the majority of US Citizens

      4.  It will lead to significant government intrusion into our health care

      5.  IT WILL lead to rationing that is far worse than anything you have experienced to date and will significantly impact on the care patients such as described by Dr. Laman will receive.  By the way, whether that lady had insurance or not - she would have gotten the same care.  It may have been at a county hospital or a university hospital - but she or you if that had been you - whether you had insurance or not - WOULD HAVE RECEIVED HIGH QUALITY CARE.  And we as a community would have paid for it.

      6.  It will lead to decisions being made that you wont be able to appeal - ones that will gravely impact your life and the life of your loved ones.

       

      So lets sit down and define what the problems really are.  Lets discuss them rationally with experts who can help solve them.  Lets stop saying me first... but look at our society as a society in which we are all involved in and come to conclusions that will bring the most good to the most people.   But by doing that - know that there will be mistakes made, people overlooked, neighbors who need help.  

       

      And we as a community should be there to help those who are less fortunate than ourselves.  It is not up to the government - as you think it is - to solve all of our problems.  We can do that collectively IF WE WORK TOGETHER - STOP PUTTING OURSELVES FIRST - AND TRY TO MAKE THIS A BETTER WORLD.

       

      Incidentally - the billions we give to other countries such as the 4.5 billion dollars that we have given to help AIDS prevention in Africa - ultimately will help us too.  Whether you want to admit it or not - we are part of a world community and as such we have responsibilities to others too.  Sure I would like to close the door and say we only need to worry about the good ol USA...but it doesnt work that way anymore.  Things that happen in China, India, Africa and the Iran affect us - in more ways than you can imagine.

       

      I hope you get your issue resolved with your physician.  And I hope that you will read widely and consider the problem of health care from many standpoints - not just your own parochial one.

       

       

    • Dr. Kirk Laman: Wholehearted Cardiologist
      Health Pro
      Aug. 18, 2009

      Thank you for your comments and opinions.