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healthcare information, Innovation in Health Professional Education, late night musing, right question, Uncategorized, value of life

Could Versus Should, The Unasked Question

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Last week, I was interviewing, and I was asked a question for which I should have been

prepared.  Of course saying this, I realize the question is one politicians, medical professionals

and the rest of the country have been trying to answer for years, so it’s not like I expect to have

the perfect answer.  After the interview, the question stuck with me to the point where I wrote

back to the interviewers thanking them for the interview and the question which had stuck with

me after the interview.  The question is one I still find myself mulling almost a week later.

“If you had a magic wand, how would you fix the healthcare system in America?” 

 

After thanking the interviewers, I wrote this:

 

As I was going home and then later putting my kids to bed, I was thinking about the question how would I use my magic wand to fix healthcare.  While I still stand by the answers of single payer and/or universal billing system as helpful to improve aggregate societal health, it occurs to me I failed to mention fixing a large part of the problem.  These are potential band aids, but they assume many decisions stay constant.  As a society we are loathe to talk about the beginning and ending of our lives.  Sex/birth control is a taboo topic and so is death.  With our reluctance to talk about these issues as a society, we all too often fail to ever come to grips with the questions of “should.”  We instead focus on the questions of “can.”  If we can, then we should is the assumption.

 

“Can we save this limb / life?” is the question we ask instead of “Should we save this life or limb and at what cost?”  I saw this when a 21 year old friend was pinned against a guard rail by a car.  She is at the 6-month post accident point, and it is still unknown whether she will ever regain use of the leg.  For less money and pain, she could be using a prosthetic and well on her way through rehab, but the assumption was they should try to save the leg because it may work.  That was how it was presented to her despite at least a 50/50 split amongst my medical friends who say they would have wanted their own leg removed.. 

 

As a society, we do not often ask what the costs will mean for our families or society.  I doubt any of my children’s birth parents ever gave a moments thought to how much the state of MD would pay to keep their children alive and later raised.  I am personally glad they did not.  However, with such a huge portion of the cost of healthcare being accrued in end of life care to prolong life for such short periods of time, at some point society will need to come to a point where we can at least acknowledge the costs and trade offs implicit in our choices or refusal to make choices.  At some point, we need to come to a point where “should” is not simply implied, and a conversation can take place.

 

I would never imply there is a universal correct answer or formula, but if I could wave my wand, I would at least get us to a point where we could talk about what our choices really imply in terms of trade offs.  Is saving my productivity for a year worth more than the cost of a college education?  Is keeping grandma alive in a coma from which she will never wake worth more than keeping a soup kitchen open for the same amount of time?  Should we use stem cells to prolong life?  Perhaps someday we will be able to bio-engineer our systems to be resistant to certain diseases, but should we do so?

 

As I think about the question of fixing our healthcare system, I am beginning to think my assumptions in our conversation were a bit misguided.  A lot of what is trending wrong happens well outside our traditional doctors’ offices and hospitals.  I also recognize much of this is outside the scope of the board except to say the presentation of the trade offs and respecting of patients views of their own trade offs is vital for any doctor.  When I think about what I like most in my neurologist, it is not just that he answers emails.  He has also never second guessed my willingness to take the riskier medications to prolong the time I can maximize my efforts to raise my kids.

 

In any event, thank you for giving me the questions to let me better phrase what I value from my doctors. 

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Child care, Family, late night musing, Noblesse Oblige, sleepless nights

Value of Effort

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“We’ve bought into the idea that education is about training and “success”, defined monetarily, rather than learning to think critically and to challenge. We should not forget that the true purpose of education is to make minds, not careers. A culture that does not grasp the vital interplay between morality and power, which mistakes management techniques for wisdom, which fails to understand that the measure of a civilization is its compassion, not its speed or ability to consume, condemns itself to death.”
― Chris Hedges, Empire of Illusion: The End of Literacy and the Triumph of Spectacle

It is such an easy thing to forget. For what do we strive? Even for those who say “the all mighty dollar,” is it the money or the things we will (not might) do with it? I’d hate to waste my life for a sheet of paper. Writ large for our society, the same remains true. What is to be the use of being the strongest wealthiest people/country in history?
On another more local note, our family continues without sleep…night after night.  For the past 2 nights my kids have added to the mix and peed themselves, and I am somewhat at a loss.  They both get up in the night to play even when they start in different rooms.  This morning I realized how tired I was last night when I got up and stepped on a matchbox car which A had lined up along the floor with a couple dozen other cars and trucks.  As I looked around, I saw her shirtless, asleep at the foot of the bed.
Thinking about it afterwards, I wonder if she takes comfort in lining up the cars as it is something in her life which she has power to make orderly.  Her mind is very grounded in concrete truths.  In a chaotic life of varying degrees of abstract truths where she assimilates more change at an ever more rapid pace, perhaps the lining up of cars is her minds way of asserting enough control to allow for rest.  She has brought order to that corner of her life.  I used to wonder why she always made her cars sit in traffic jams moving each of them 1 inch forward at a time instead of racing around like I see most kids play.  I hate traffic, but then I never considered how the slow motion might be calming.
 
I, of course, slept through everything.  That’s my mind’s way when the days grow ever longer, and respite from confusion and pain seems further away. Time in a loving wife’s embrace seems such a distant goal.  Still, even on a morning where I hurt from lack of rest,  I take great solace that my time and effort is spent on something more valuable than paper.  As someone to whom much has been given, I hope I spend raising the value of our family’s culture, and through them our society as a whole may gain.  What more should we ask?
 
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