W’s Stent
This is a really great opinion piece in the Washington Post from a physician, Vinay Prasad MD. He talks about how George W. Bush recently received a stent in his heart without any history of having symptoms. If W. was a regular citizen, he would not even have been given a cardiac test to check for blockages. Evidence does not support any benefit in testing asymptomatic people! The author sums it up by saying:
Although this may seem like an issue important only to the former president, consider the following: Although the price of excessive screening of so-called VIPs is usually paid for privately, follow-up tests, only “necessary” because of the initial unnecessary screening test, are usually paid for by Medicare, further stressing our health-care system. The media coverage of interventions like Mr. Bush’s also leads patients to pressure their own doctors for unwarranted and excessive care.
I have always believed that rationing, done in an appropriate and evidence-based manner, is warranted. We physicians are still stewards of the healthcare system and when you run out of money doing stupid tests and procedures then no one gets healthcare. That being said, politicians have never followed the same rules of us common folk. Why else would they have excluded themselves from Obamacare?
I worried about the necessity of the stent when I heard about it. But I agree with Chris that it’s possibly preventive medicine in this case.
I also wondered about the fact that W is – and has been – so active all these years, but was found to have enough disease to spur his docs to place the stent!
Look actual preventive Medicine. Just what we aRE TOLD TO DO, BUT NEVER ALLOWED. Sorry small keyboard but ending the sentence shouting is appropriate. Examine what is done for soldiers and what is done for citizens. In the military this type of prevention is not that atypical. He would also get a full panel of blood work and an EKG. In addition to the stress test he probably got a colonoscopy. Or what they called a “physical” when I was in school.
Of course, if W. paid for his own stents, why the hell should I care? And where do we draw the rationed line? We’ve determined that Granny and Grandpa should have ACE/digoxin/diuretic, echoes, and cardiology consultations gratis. We’ve determined that demented, contracted nursing home patients deserve full-court press ICU services. Evidence certainly wouldn’t support the latter, and both instances cost the taxpayer – as opposed to the patient – big bucks. My point, academic admittedly, is that we should have no problem what W. or any private citizen shells out. To me, this story is more about the fundamental flaw in government-provided care, which Bush ’43 supported and expanded.
I agree; why can’t patients ration themselves based on competitive prices? Taking the paternalistic (RVU) view that imposes a fixed value on all things ignores what patients want causes plenty of problems, and physicians should have the right to refuse what are evaluated as unnecessary procedures — even at risk of losing those patients.