Clear Vision

We had company over last night. One guest who is an ophthalmologist (eye surgeon) was telling how she recently outraged a family by refusing to do a cataract surgery on their elderly mother. The elderly woman was in a nursing home with a far progressed Alzheimer's, and the family knew her vision was down due to a cataract. So they brought her in with a request of restoring her vision surgically so that their Mom could have a few more months or years of enjoying clear vision while senselessly staring into the ceiling or wherever her gaze happened to fall. The doctor said that upon the examination, the patient was totally unresponsive, sitting in a chair and banging her forearm against her chest repeatedly. She would not make an eye contact, she would not answer any simple questions, and the doctor had no way of examining how bad her eyesight was. A surgery - WHICH THIS PATIENT WOULD BE ENTITLED TO FOR FREE UNDER THE CURRENT SYSTEM - would have meant that after the procedure she would have to be restrained and wearing a helmet to prevent her from rubbing her eyes for a period of time. There were also some other medical ramifications which made the survival of the surgery and the recovery process very problematic at best. Bottom line - this was an unnecessary procedure, it was not going to enhance the patient's quality of life in any way, and it was medically dangerous. The family was furious with the doctor's decision and accused her of refusing to operate because the patient had Alzheimer's (duh! hello, Sarah Palin with her "death panels!"). The doctor has referred them to a different physician who, in her words, would operate on a corpse.

Things like that run up the cost of our health care without helping the nation to feel better. A girl with diabetes working two part time jobs would be without health insurance coverage for her preexisting condition for a number of years even if she buys a policy, while some nonagenarians in a vegetative state qualify to get a heart transplant for free. What use is clear vision to an Alzheimer patient whose brain is gone?

I want to mention two excellent books, both written by physicians, which explain what makes the American medical system sick (beyond the run amock malpractice system which alone accounts for 25% of the unnecessary spending on defensive medicne). The authors were not supported by grants from any special interest groups, like pharmaceutical or insurance companies. Both books refere to multiple studies the results of which are so often twisted and fed to the public in the altered form to justify bigger spending (but not better results). So here are those books:

John Abramson, M. D. "Overdosed America: The Broken Promise of American Medicine. How the Pharmaceutical Companies Are Corrupting Science, Misleading Doctors, and Threatening Your Health." HarperCollins Publishers, 2005.

Nortin M. Hadler, M.D, "Worried Sick. A Prescription for Health in and Overtreated America." The University of North Carolina Press, Chapel Hill, 2008.