The Permanent Address Book

Friday, February 20, 2009
I broke the news to Evelyn. My aunt, Jean Davis, died early Saturday morning. It was my duty to call all of her friends, make the final arrangements, and help my mother, her sister, get through the day.

Jean Davis passed away peacefully on February 14th. The funeral, per Jewish tradition, was on the 15th. There wasn't a lot of time to get everything done. I was prepared. Last summer I had visited my aunt in her Columbus nursing home room specifically to review her personal phone book, entry by entry. Our goal was for me to know who to call when she finally succumbed to her illnesses.

My mother took the red eye from Los Angeles. My brother Rob flew in from New York. My children, Phillip and Jennifer, and a dozen or so of Jean's friends attended the funeral.

Now you may be wondering why this is in my blog and what this has to do with the delivery of health care. Without shortchanging the importance of the funeral of a woman of limited means which was officiated by three Rabbis and a Cantor, there is an interesting parallel. And it has to do with Evelyn. Evelyn missed the funeral.

Evelyn didn't get back to Westerville, Ohio from her vacation until Wednesday. I had left a message on her machine to call me. She did not know that her friend had died until we talked. Evelyn doesn't know any of my aunt's friends or family. She never met Jean's closest friend, Doty, nor Jean's sister, Gerna, nor even the woman who held the medical power of attorney. Since she had stopped the Dispatch while away, she would have never seen the obituary. Had I not recorded her name, address, and phone number and tried to contact her, Evelyn might never have known that Aunt Jean had died. And we, or at least me, would have never known about her.

Our health care delivery system is remarkably similar to Jean's address book. Our providers are randomly connected. Sometimes our doctors know each other and have access to all of our records and information. More often than not, our doctors have no idea what medications we've been prescribed, what lab and diagnostic tests we have taken, and what we need, holistically, to thrive.

My allergy doctor had me on three prescription medications in the late 1990's. I know, pretty ridiculous. Still, I religiously took a pill, eye drops, and used a nose spray daily for years. One winter I caught a flu and my internist prescribed an antibiotic. As the pharmacist handed the bag to me, he asked in an off-hand way if I was taking any other medications. I rattled off my three meds and he freaked. Death was one of the possible side effects of mixing my allergy medications with the contents of his bag. My doctors, with offices in the same building, were total strangers when it came to treating me.

One of this administration's goals is to create a new system, a communication system. If we could modernize our system of record keeping and information transmission, we may save an incredible amount of money. More importantly, we may save lives.

Kaiser Permanente and the Veteran's Administration are leaders in records modernization. But the concept can work with every doctor and hospital. Getting complete up-to-date information into the hands of caregivers will help them to see the whole patient. We can not eliminate medical errors, but we can reduce those problems that arise from inadequate health histories.

Evelyn and Doty will remain strangers and both will miss my aunt. My internist and allergy doctor almost had the chance to miss me, too.

An End to Unlimited Care

Monday, February 2, 2009
In a recent issue of Newsweek, Robert J. Samuelson, citing a variety of experts and studies, concludes that our health care spending is out of control because of our behavior. We "receive more medical services than other people do, and pay more for them." He goes on to note that we get more CT scans, knee and hip replacements than other wealthy countries. Our system encourages medical providers to use every tool, run every test, and prescribe every possible medication to treat us when we are sick or injured to forestall the inevitable.

It is our fault. We expect to be cured and damn the cost.

A friend in his late seventies is on THE LIST. He is waiting for a kidney. Since he is in his seventies, you and I will be paying for this surgery through Medicare should he ever get to the front of the line. Is it logical to perform a kidney transplant on an unhealthy seventy-plus year old? Would this procedure be performed in Canada? In France? In Michael Moore's beloved Cuba?

Does the ability to access expensive procedures at almost any age make our current system better? Not until you are the patient on the gurney. It is easy to point to incredible waste and countless questionable decisions. But, are you willing to take one for the team?

Metaphorically, would you be checking that list daily if our ailing gentleman was your father? What if the patient was YOU? Where is the line? These aren't simply theoretical questions. There is an international black market in transplant-able kidneys. If you are one of millions of Americans breathlessly anticipating a change in our health care delivery system, you should begin to think about issues of access. And the time to think about access and how it will change is now.

The payment and delivery of health care in the United States must change. There is too much pressure, political and financial, for Congress to ignore. This is good. Our current system is a hodgepodge of stop-gap measures masquerading as a solution. Unfortunately, some of the most vocal proponents of change have some of the most unrealistic answers to this questions. We can not have unfettered access to any and all care without restriction or cost.

So again, are you willing to take one for the team?