Monday, December 10, 2012

Too much freedom

I was chatting with The Second Doctor last night about some of the issues with Canadian medical care.  Unlike what much of the American press would have us believe the issue is not so much that Canadian medical care is bad, but rather that it is too good in the wrong ways.  There is a huge amount of emphasis put on patient autonomy, which is a noble goal after all, but which regularly ends up with the system groaning under the burden of foolish, wasteful, or pointless care.

Whether it be patients getting antibiotics for viral illnesses, expensive but mostly ineffectual treatments for cardiovascular illness, endless rounds of cancer treatments for people who have no chance of survival, or desperately resuscitating people who have no chance at ever leaving their hospital room again (nor enjoying their stay), we pour money down endless holes.  Fortunately the great majority of these holes can be plugged simply by making sensible decisions but unfortunately we allow patients to make the determinations rather than doctors.  Sometimes the patients (or their families) make the right choices and sometimes they do not.

Patients used to have far less autonomy and in many cases that was a real disaster.  Physicians were the ones making final choices and, of course, they sometimes got it wrong.  No matter what system of decision making we use there will be mistakes made but we must strive to find the point where the greatest good is being done.  Letting people be informed and make decisions is good but letting them beggar the system with their errors is not.

We don't like to talk this way; much of our public discourse on the topic is filled with platitudes that assume that a literally infinite amount of money is available from the government if they would just be nice enough to hand it over.  That obviously isn't the case and the faster we can acknowledge that letting patients set fire to public funds *hurts other patients* and get a more responsible system in place the better off we will all be.  The greatest good includes telling people "Sorry, that treatment is inappropriate and we will not perform it" more often than we do right now.

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