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Guest column | Dr. Rao Musunuru

Strike balance among profits, progress and passion in medicine

More than 50 years ago, President John F. Kennedy, in talking about the space program, said "the greater our knowledge increases, the greater our ignorance unfolds."

The same holds true for medicine. When I was doing my cardiology fellowship in 1979, a patient who sustained a heart attack stayed in bed in the coronary care unit for more than a week, receiving precautionary intravenous medication to treat premature heart beats. Blood thinners were prohibited, for fear of bleeding around the heart. Ultrasound and nuclear testing of the heart were primitive. There were few not-so-effective intravenous medications to treat a fast heart rate and no intravenous medications to treat chest pain, except morphine. Preliminary pacemakers saved lives, but sometimes deteriorated the quality of life.

Fast forward to 2013. We get the patients out of bed as soon as possible after a heart attack. We don't give any routine intravenous medication to treat heart rhythm, as it was killing more patients. We take them to the cath lab and open the blocked blood vessels, within an hour or two, using many different blood thinners as the mainstay of treatment. We now have several choices of intravenous medications, which work instantaneously, to treat fast heart and chest pain. We have many types of pacemakers and even implantable defibrillators not only to treat a slow heart, fast heart and heart failure, but also to prevent sudden cardiac death.

Now, we have many kinds of three dimensional and four dimensional ultra sounds, nuclear scans, MRI and electrical mapping to study the heart. We almost replaced open heart surgery and carotid artery surgery, using stents to treat symptoms from clogged blood vessels and also for treatment of aneurysms. We started with stem cell therapy, and advancing to cell therapy without cells. "Genomics, proteomics, metabolomics and nanomedicine" – words that were never heard until recently – will bring new advances for therapy in the near future.

The same is true in all other specialties. The technological advances expanding exponentially are adding enormous expenditure to health care, even though they help people to live not only longer but also stronger. People demand more and more tests and treatments, even in the terminal stages. The payers (both private and government) restrict what can be done. Physicians are squeezed in the middle. The pleasure of the practice of medicine is being replaced by the pressure of limitations and liability.

As a result, the passion for medicine and compassion for people is taking a back seat. The technology, including electronic medical records is replacing the healing power of simple words and the soothing power of a tender touch.

The lifesaving physicians became mere providers, forced to sign contracts with insurance companies. The offices became centers. Health care became an industry. Clinicians became gatekeepers and the doctors became data collectors. Dealing with patient's problems became secondary to documentation. Triumph of a physician is being decided on his or her typing and computer skills rather than treatment skills. Patient care is being managed by physician extenders, while the trained physicians are busy dotting the I's and crossing the T's. The doctor who follows guidelines without any independent thought or individual judgment receives all the financial rewards. Computers are replacing common sense.

Care is becoming impersonal, even though one will be hard pressed to find a single physician or nurse who would enjoy spending more time on the computer instead of with the patient.

"The good doctor treats the disease; the great doctor treats the patient with a disease," said Sir William Osler, one of the greatest physicians in history.

The forces that control the health care providers and health care expenditure need to find the right balance among progress, profits, payments and passion.

Dr. Rao Musunuru is a practicing cardiologist in Bayonet Point.

Strike balance among profits, progress and passion in medicine 01/09/13 [Last modified: Wednesday, January 9, 2013 4:44pm]
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