What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Friday, August 04, 2006

Lives Lost, Which Are Justified?

Wow, we are now looking at rationing Emergency Medical Services in an effort to make it more cost effective. A recent article in the New England Journal of Medicine (according to the Calgary Herald’s Aug. 3rd, edition) reports that by using three simple criteria, EMS could reduce by two thirds the number of cardiac arrest patients taken to hospital. Notably, this is not because they have “saved” them, but rather a decision would be made that attempts to resuscitate them ‘would be futile”, so why waste the time and effort. If I read the article correctly, the term “futile” is equated to a success rate of 0.5%. In this article, a Dr. Laurie J. Morrison states that in a series of 1,240 cardiac arrest patients, three percent were successfully resuscitated. Two thirds of these patients could have been taken to the morgue instead of the hospital, and the system would have saved the time and expense of attempted resuscitation and transport to the hospital. The loss of life would have merely been 0.5%; approximately one in two hundred. Am I reading this right? In a given life and death situation, it is acceptable to loose one in two hundred people without trying?
The article states that 300,000 Americans die of cardiac arrest each year. Comparing populations and the fact that our life expectancy in Canada is not much different in Canada, somewhere around 30,000 Canadians likely die of cardiac arrest each year. By using those magic three criteria, we could have saved our time, energy and transportation costs on 20,000 of them. So what if 100 would have survived with appropriate intervention (0.5% of 20,000), look at the money being saved!
On the other hand, we Canadians seem to think that intervening and transporting 14,000 Lebanese/Canadians (at great expense) from Lebanon, following the death of four Canadians, was a must. We are aghast at the fact that 17 soldiers have died attempting to bring peace to Afghanistan this year; but sacrificing 100 lives annually for our “Universal Health Care God” is presented in the Calgary Herald with the positive spin headline “New rescue test IDs futile cases” and “Lost causes can tie up ambulances, ER departments”. And so the rationing of health care services in Canada continues and a blind eye is turned to its casualties. Hopefully, when you call the Emergency Medical Services to attend your father/husband/brother/mother/sister/wife’s cardiac arrest, the EMS will give your loved one the benefit of NOT applying those three cost saving criteria!


Blogger Lanny said...

Excellent post. It really is amazing how these things are happening and where the priorities are being put. Society is corrupting like the frog in boiling water. Put a frog in a pot of cool water and warm it up slowly and it won't jump out. Unfortunately, the media keeps telling the frog the water isn't boiling.

4/8/06 1:04 PM  
Blogger Al said...

Right on, good analogy. Not only are we told that the water isn't boiling, but we are continually told that it isn't even warming (that it won't impact us)even though we are continually bombarded by evidence of escalating tragedies. Not only do we as Canadians see the effects of the "water heating up", but organizations such as the World Health Organization recognize the change (most recently ranked Canada 30th in health care outcomes---a progressive and continuous decline)

4/8/06 5:08 PM  
Blogger Money Bags4Me said...

We really seem to have little understanding of costs and benefits and therefore how to priorize these days. Its all about irrational emotional hysteria when some cold clear logic could actually show us where to make a difference. Good on yah Al for pointing to a real world example.

4/8/06 10:05 PM  

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