Efectes hemodinamics del tractament osteopàtic aplicat immediatament després de la realització d\’una intervenció de Bypass (Hemodynamic Effects of Osteopathic Manipulative Treatment Immediately After Coronary Artery Bypass Graft Surgerys)

Five years ago, Indonesian Goenawan Endro started experiencing tightness at his chest area and chest pain. Visits to the doctor in his hometown Surabaya revealed that he had a heart problem. He was prescribed medication, told to stop smoking and was recommended to go for a balloon angioplasty. Mr Goenawan took all but the advice to go for the angioplasty as he felt that his medication was enough for him. He was also apprehensive of the complications that may arise from the procedure. He had since changed doctors three times.

In end 2005, Mr Goenawan’s symptoms took a turn for the worse and he suffered a heart attack. The doctor Mr Goenawan saw after his heart attack suggested that he should go through the angioplasty for his own good. This time round, Mr Goenawan complied. “Dr Irwan is very patient, he is unlike my previous doctors who only instructed me to go for the angioplasty without being able to tell me exactly why I needed to do it. This doctor explained my condition in detail and the need to go for the procedure. After 2 to 3 visits, I was finally convinced to go for the procedure,” said Mr Goenawan.

The angioplasty revealed that Mr Goenawan had very serious blockages in his arteries – total blockage on his left side and 20 to 30% on his right. Given the results, Dr Irwan advised him to go for a Coronary Artery Bypass Graft (CABG). Dr Irwan provided him with the choice of undergoing treatment locally, in Indonesia or in Singapore. He was informed that the National Heart Centre of Singapore (NHC) offered a comprehensive and affordable package that suited his needs. Mr Goenawan finally decided on Singapore after strong recommendations from friends and relatives.

Arrangements were made with a Global Patient Services Officer at the National Heart Centre and the family took a flight over to Singapore. At the National Heart Centre, the cardiothoracic surgeons performed a successful CABG on Mr Goenawan. Post-operation, he was warded for observation for 6 days.

Visibly happy with the success of his operation and positive experience at the National Heart Centre, Mr Goenawan gave two thumbs-up to the staff of the National Heart Centre, “The service quality is very good, we felt welcomed and I was well taken care of. The nurses, especially those in the intensive care unit, were professional and kind. My doctor-in-charge, Dr Sin, was very informative and professional as well. I also did not have much problems communicating with him because he could speak Bahasa Indonesia.”

Click here to read complete story at PlacidWay.com

Journalists Ezra Klein and Peter Suderman debate the government’s role in the future of U.S. Health Care (thank you Healthcare Economist).  Whose argument carries more weight?

Klein’s main argument is decidedly anti-libertarian, which makes perfect sense because I don’t think he is a Libertarian.  Klein’s conclusion is that it will take substantial government resources, research and intervention to improve health care economics and yield better outcomes.  He supports it with the following statements: “the individual consumer will never have enough information or enough expertise to exert effective control over the medical industry. People don’t comparison shop when they have a heart attack, they don’t know how to effectively contrast chemotherapy providers when their doctor tells them they need to start treatment now. Confronting illness — much less physical trauma — is not like buying a television. You can’t walk away from the deal, and you’re in a terrific state of fear and urgency before you ever speak to a salesman.”  Essentially he’s saying that giving the consumer access to price and procedural information will not make them discernably more efficient consumers of health care – because health care is more fear-driven than any other money-spending endeavor.  In some cases this is true.  If you’re imminent fear of dying, you want the best care, rather than the cheapest.

There are three fundamental flaws with this: (1) very few medical decisions contain the type of fear Klein describes – in fact most health care dollars are spent in preventative care and chronic disease management where cost certainly does play a role – all the crap that, if you screw it up, leads to the coronary artery bypass situation described above; (2) even if the decision is emotional (aren’t all decisions at some level?), price transparency still provides valuable feedback – perhaps the patient wants the most expensive treatment…associating it with the highest likelihood of survival.  If the information lacks the requisite transparency, the patient could err and make the wrong choice.  More and better information is always better than less and worse information, regardless of the emotional state of the consumer; and (3) if the consumer will “never have enough” information to make an informed decision, who will?  Life and death decisions are made between physician and patient everyday.  If we’re going to say the patient isn’t qualified to act on his or her own behalf, are we prepared to say Medicare is?  

(3) really gets at the heart of my philosophical issues with Klein’s argument.  If we are prepared to strip consumers of the right to make their own medical decisions, we must be prepared to say they are not moral agents.  The government should decide all kinds of things about how they live their lives, no?  Isn’t that contrary to the very notion of freedom? 

Suderman’s response is right on: “I’m apprehensive about the idea that individuals shouldn’t be trusted—or at least given the option—to manage and determine as many of their own health decisions as possible. And for another—and this was my original point—even if your government-run comparative effectiveness research board consists of the most honest, decent, and committed public servants in the history of the nation, they’re still going to be subject to a variety of outside incentives.”

In the case of biased bureaucrat and emotional patient – emotional patient is the lesser of two evils…particularly when the issue at bar is the patient’s life.

If I’m wrong, tell me…