Ethics, Quality, Compassion

I listened carefully to President Obama's AARP televised and internet-carried conference On July 29, 2009. I heard nothing about the ethical construct for health reform. I heard nothing about health care quality. I heard nothing about assuring Americans that there would be competent qualified physicians available to provide the care that is being promised to them. I find myself more and more concerned that the only subject for Obama and Congress seems to be cutting health care cost inflation and saving money.

I have proposed changes to the health system in earlier blogs. Others have proposed different changes. But the only change that seems to be in the wind is that insurers and pharmaceutical companies' revenues and profits will be protected, with no apparent concern for the quality and ethics for the services they provide.

Years ago, one of my patients with advanced metastatic breast cancer was in the Oncology Unit of a local hospital with a fractured hip. She was in agony and her quality of life was poor, but could have been helped by appropriate orthopedic surgery. MediCal (California's Medicaid) refused, saying that the expense was not justified by the patient's poor prognosis. I called the MediCal authorization number and asked Medical's "authorizer" for the address of MediCal's office. She asked why I wanted to know. I told her that it was because I was going to put the patient in an ambulance and send her to their office for care, because I couldn't take care of her under the circumstances they dictated. After a few moments of silence, I received the authorization. The patient had surgery by a competent and compassionate orthopedic surgeon, went home without devastating hip pain and died several months later appreciative that her pain had been treated, her ability to walk restored, and she could be at home with her family.

I have seen the value of ethical commitment, concern about the quality of care that patients receive and compassion. It is unfortunate that Congress does not address these issues. The Administration and Congress just don't have the words to discuss ethics, quality of medical care, and compassion.