Rationing: The 800-lb. gorilla in the room
Rationing: The 800-lb. gorilla in the room
Will the new Obama administration successfully address emergency medicine's most pressing problems? Some are not hopeful.
"During the campaign, nobody talked about it," says Gregory Henry, MD, FACEP, vice president of risk management, Emergency Physicians Medical Group, Ann Arbor, MI.
"It," explains Henry, is the rationing of care. "We're filling our beds with patients who need huge amounts of work-up, who no one wants to admit, and we cannot come to a final agreement on what happens to them," he says. "Grandma has pneumonia, is demented, and has COPD [chronic obstructive pulmonary disease]. What are you prepared to do for her?" There are no answers forthcoming, he says, "because nobody wants to carry on this discussion publicly."
And yet, Henry continues, it must be discussed because it only is getting worse. "The single largest change in the last 30 years is who populates the ED," he says. "Because of things like seatbelts and improved care dynamics, we are seeing far fewer trauma patients."
Most ED patients, Henry says, are "nursing home types" at the end of their lives. "They require huge amounts of therapy and spend long times in the department, but it's OK to die in a nursing home," he says. "If someone is demented and is going downhill, and if we have nothing to truly offer them, why do you send them to the ED?"
Rationing, however, is not a popular concept, and it certainly is a dangerous political issue. "It takes somebody with some guts to say this or that will not be provided, and it needs be done on an across-the-board basis, because no individual doctor can be put in the position of denying anyone health care," Henry concludes.
Will the new Obama administration successfully address emergency medicine's most pressing problems? Some are not hopeful.Subscribe Now for Access
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