By Dr. J. Deane Waldman
University of New Mexico professorIn the Albuquerque Journal, Dec. 20, Dr. Frank Hesse detailed the problems we have with doctor shortages, and he was spot on. In the Journal, Dec. 16, reporter Winthrop Quigley detailed the plans for cutbacks in Medicare to save money.
Many in this country are aware of the heparin overdoses inadvertently given to Dennis Quaid's twin babies.
People discuss these problems in exquisite detail and then move on directly to treatment. This is not practicing good medicine.
To cure anything requires evidence-based medicine, whether the patient is a single person, a community or our entire health care system. We first need a diagnosis of what is wrong. Then we need the why of that diagnosis because effective therapy is aimed at the why. You treat the reason for a headache rather that just giving morphine.
Do we know why there is a shortage of doctors, why Medicare is running out of money, or why there are so many drug errors and complications? Though this article appears in the Op-Ed section, the assertions below are not simply the author's opinions. There is solid evidence for each of the following "whys."
We all experience shortages of doctors and nurses, and the problem is getting worse. Fewer people are entering health care and more are leaving early— that is not the why but the how: the mechanism of shortages. The why is professional dissatisfaction, and money is only a tiny part of it. If we want to cure these shortages, the treatment must improve professional satisfaction.
Medicare is running out of money because the system considers only short-term costs. The "why" is a measurement problem: too short a time frame and no positive outcomes. If you want the money to be there for you, we have to start rewarding long-term value— a net positive lifetime cost/benefit ratio.
The "why" of medication complications is the easiest to understand and even to cure. Computer experts say it is child's play to design a national drug dispensing program that would prevent a person from getting the wrong drug, the right drug at the wrong dosage, too many drugs, or drugs that have a bad interaction. All we need is the will and enabling, rather than constraining, laws.
To start fixing our health care system, we have to practice good medicine: treat causes, not symptoms.
Dr. Waldman is a University of New Mexico professor in the Health Sciences Center and the Robert O. Anderson Graduate Schools of Management. See: www.admhealthcareconsulting.com/blog.
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