Saturday, May 26, 2018
Opinion

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.

Comments
Editorial: Welcome Bayshore changes still canít stop bad judgment

Editorial: Welcome Bayshore changes still canít stop bad judgment

Itís human nature in following any tragedy to imagine: How could this have been prevented? On that score, the city of Tampa responded appropriately to the deaths this week of a mother and her toddler whom police say were hit by a teenage driver racin...
Published: 05/25/18
Editorial: Filling Rocky Point lagoon to build townhomes is an empty-headed idea

Editorial: Filling Rocky Point lagoon to build townhomes is an empty-headed idea

One of the worst ideas in a long time in the field of urban planning received a blessing this month when the Hillsborough County City-County Planning Commission approved a land-use change for a project that calls for filling three acres of water insi...
Published: 05/25/18
Editorial: Searching for the real Adam Putnam

Editorial: Searching for the real Adam Putnam

Send out an Amber Alert for Adam Putnam. The red-haired, affable fellow who has served capably as a state legislator, member of Congress and agriculture commissioner is missing. In his place is a far-right caricature who has branded himself as a prou...
Published: 05/24/18
Updated: 05/25/18
Editorial: A strong economic case for restoring voting rights for felons

Editorial: A strong economic case for restoring voting rights for felons

Floridians are paying a steep price for a system that makes it as difficult as possible for people who leave prison to reintegrate into civic life. Gov. Rick Scottís clemency process isnít just archaic and cruel ó it also wastes enormous public resou...
Published: 05/24/18
Updated: 05/25/18
Editorial: Trump right to cancel North Korea talks on nuclear weapons

Editorial: Trump right to cancel North Korea talks on nuclear weapons

Regardless of the reason, the cancellation of the U.S.-North Korea summit to address Pyonyangís nuclear program is hardly the worst possible outcome of this high-stakes diplomatic gamble. President Donald Trump was unprepared, North Koreaís Kim Jong ...
Published: 05/24/18
Updated: 05/25/18

NFL kneels before the altar of profits

The owners of the 32 National Football League teams sent a wrongheaded and, frankly, un-American message to their players Wednesday: Expressing your opinion during the national anthem is no longer permitted."A club will be fined by the League if its ...
Published: 05/24/18

Editorial: A positive first step in ensuring student access at USFSP

As a task force sorts out countless details involved in folding the University of South Florida St. Petersburg back into the major research university based in Tampa, ensuring access for good Pinellas students remains a concern. An enhanced cooperati...
Published: 05/23/18
Updated: 05/25/18
Editorial: Banks still need watching after easing Dodd-Frank rules

Editorial: Banks still need watching after easing Dodd-Frank rules

Legislation that waters down the 2010 Dodd-Frank law and was sent to President Donald Trump this week is a mixed bag at best. Some provisions recognize that Congress may have gone too far in some areas in the wake of the Great Recession to place new ...
Published: 05/23/18
Updated: 05/24/18
Editorial: Honoring our fallen soldiers on Memorial Day

Editorial: Honoring our fallen soldiers on Memorial Day

The rising tensions with Iran, the resurgence of violence in the Mideast and the uncertainty over a nuclear disarmament deal with North Korea combine to create an unsettling time this Memorial Day. These grave threats to peace are another reminder of...
Published: 05/22/18
Updated: 05/25/18

Another voice: The chutzpah of these men

A new phase of the #MeToo movement may be upon us. Call it the "not so fast" era: Powerful men who plotted career comebacks mere months after being taken down by accusations of sexual misconduct now face even more alarming claims.Mario Batali, the ce...
Published: 05/22/18
Updated: 05/23/18