Slade Letter - 08/19/09

The outrage on the part of many Americans over the government option health care bills now before both houses of Congress has left me totally baffled, but then the average American has little idea of what goes on in the nation's hospitals. The 20 years I spent working in them left me with a totally different perspective.

Firstly, hospitals and health care are money-driven, not health care-driven. What's best for the patient is too often given a backseat to what is profitable, such as unnecessary surgeries and irrational use of expensive, often ineffective medications.

The drive for dollars has produced the attitude in many hospitals that the doctor is the customer, not the patient. It is the doctor who brings in the dollars, who is the gatekeeper to the institution, the man to whom deference must be paid. This deference has been expensive. It has been said that the most expensive piece of equipment in any hospital is the physician's pen.

As pharmacists, we frequently ran into physicians who were incapable of writing legible, explicit orders, and who refused to do so. This is the chief source of medication errors in hospitals that allow MDs to use hand-written orders, yet most hospitals do not require computer-generated orders, because many MDs will not use them.

It is common knowledge that a medical database for every American would contribute efficiencies we have not begun to exploit, yet many Americans are outraged at the idea of government having access to this information. They don't object to insurance companies, far more likely to exploit them, having the same information. Other nations, such as Sweden, have had these technologies in place for 20 years.

Because many physicians are not aware of drug costs or, for that matter, have no ability to prescribe medications in a cost-effective manner, the pharmaceutical companies exploit their ignorance routinely with misleading claims for their particular product.

The above examples are only the tip of the iceberg. The inconsistencies, inadequacies, inefficiencies are encyclopedic, and would require far more space than is available here.

Suffice it to say that our health care system is bloated, inefficient, and the most expensive in the world. This is one reason we are not listed in the top 10 nations for quality of life, and why we rank 37th in the world for quality of health care, right next to Costa Rica.

Ron Slade Sr., Pharm.D.