5 top medical comments, June 14th 2009

Here are some of the more interesting comments readers have left recently.

1. Carla Kakutani on how Massachusetts’ health reform won’t relieve ER overcrowding:
Insurance does not equal access (although it’s better than nothing). Nothing changes until every stakeholder recognizes they have to control costs and allow a rebuilding of primary care in the US. That includes doctors and patients, along with everybody’s favorite villians, the insurance companies and big pharma. Let’s hope we make some significant movement forward with this opportunity, rather than just a few cosmetic changes.

2. Bryan Stoudt on resident work hours:
I am a pastor to medical students and health care professionals, and many tell me that a top priority (especially as they advance in their training and career) is balance. It seems to me that eighty-hour work weeks do not leave much time for things such as family and other facets of life that are just as important as our careers.

Although I do not pretend to have an easy solution, I do feel that failing to consider the issue of balance from many discussions on the topic reveals our culture’s overemphasis on the value of work.

3. Melissa on fighting the anti-vaccine trend:
“And perhaps we should not be so quick to embrace every new vaccine that comes out. Let’s focus on what is already recommended.”

As a mother I heartily agree with this. My daughter (2.5) has had everything recommended by the CDC other than rotavirus. It had just been reintroduced when she should have started it and the pediatrician we saw wasn’t even stocking it. I think the Hep B, varicella and rotavirus vaccinations are questionable as far as actual need and danger of these diseases. The simple truth is that if the medical establishment insists that we worry about every little thing the reality will be that we take things like measles, mumps, diphtheria much less seriously.

All that said, I think the tide will turn when these hippy granola communities start seeing lots of kids with measles, mumps and pertussis. I’ve already seen one news story about a playgroup that asked and non-vaccinating mom to withdraw herself and her child.

4. Finn on whether patient-centered care can be taken too far:
This sounds a lot like the “child-centered” education movement, in which schools & teachers don’t instruct children but instead assist them in “exploring” whatever provokes their interest. While this can work well for the tiny minority of intelligent, self-motivating, broadly curious children, it’s a prescription for disaster when applied on a broad scale.

Similarly, “patient-centered” care that allows patient preference to trump evidence-based medicine will, in short order, render antibiotics useless as constant patient demand for them to treat viral infections turns all common bacteria into antibiotic-resistant strains.

5. Andrew Holtz on the benefits, or lack thereof, of executive physicals:
I could agree with the “Why not?” comments, IF the executives (or their companies) pay for follow-up tests and treatments, without shifting any of the charges to private or public insurers.

But it is not okay for someone without symptoms or other indications to get a coronary artery CT, for example, (even at their own expense), if they then stick their insurance company (and ultimately all the other clients in that insurance pool) with the far larger bill for follow up examinations.

Studies of “whole-body CT” find that most people will have something show up that prompts further tests. So even if they paid for the first scan, others get stuck with the rest of the bill… even though there is no evidence that this sort of screening produces better overall health outcomes.