http://www.washingtonpost.com/opinions/charles-krauthammer-the-health-care-myths-we-live-by/2014/02/06/8a74d7b2-8f66-11e3-84e1-27626c5ef5fb_story.html?tid=pm_pop


Being a nurse I found this article from 'The Washington Post' interesting.  Alot of the information provided are issues that we observe in the hospital setting. We are often frustrated by the same circumstances that are mentioned in this article. The commentary touches on, but does not explain in depth, why these discrepancies between fact and fiction may exist.

The author, Charles Krauthammer, does have medical background. Mr. Krauthammer practiced medicine for three years as a resident and progressed as a chief resident in psychiatry at Massachusetts General Hospital in the 1980s. It is interesting how his background in medicine and current status as a political commentator (on Fox news) mesh and co-exist. He was also a speechwriter for Vice President Walter Mondate and helped direct planning in psychiatric research for the Carter administration.

I found this article to raise some interesting questions, but it left me with many more questions and not alot of answers.

Below I have addressed several of the topics mentioned in Mr. Krauthammer's  editorial entitled, "The health-care myths we live by".

On the issue of vitamin supplements and the ongoing debate on whether they are useful, useless or harmful continues, as stated in the article. Why might this issue continue to baffle? The issue exists because the studies and experiments used to determine situations such as these (supplement effects) are reported in lag time. A delayed reaction if you will. Many of the studies and research that are conducted take an extremely long period of time to complete and are done in a variety of different environments, with different populations, and under varying circumstances. Thus, since the outcomes of the research become available at different times (depending on the technology available at the specific time the studies were conducted) and invariably are different. The outcomes of the research , since many of the studies conducted are not the same - but are testing essentially the same or nearly the same hypothesis - are going to be in conflict. It is similar to attempting to do research on the internet - you are going to find claims against and for an argument - but this gets an indivdual no closer to the truth, unfortunately. This is why some studies for supplements (and depending on who is conducting the research and whether they are wanting a positive or negative outcome) are going to be in favor of them and others against them. You also have outdated information that some portion of the population has latched on to, while updated information is being circulated as well. As the article mentions, antioxidants have long been touted to be beneficial, while new research may be suggesting that to be untrue or that they may even be harmful - it will take a certain amount of time for that information to circulate and become common knowledge.

In the medical community, generally, procedures are continued to be viewed as a staple and actively practiced until concrete evidence is available to challenge it.  As in the case of tonsillectomies, this was a widely practiced procedure - then when the research came back that it was unnecessary, for the most part, the routine procedure was, in most cases, abruptly stopped. In the medical community, issues are often based on scientific fact. The medical community is unable to waver back and forth on an issue, it must come together, examine the evidence, and make a concrete decision and stick by it. The medical community actually has to ACT ON the said research - not just decide to be for or against it - and to actually believe in it and take an active stance on it.

The author's suggestion that, "This is not to indict, but simply to advocate for caution grounded in humility" is fine for the average person, but what if you are a nurse or doctor having to assimilate fact from, literally, "fact", and actively practice and incorporate the information into your profession? Humility is not really the issue - it's an issue of attempting to provide the most accurate data available for the medical community to make the best decisions possible for it's patients. Often if a medical provider is not confident in the information that is being provided to patients, the patients become frustrated and are incapable of making individual health decisions - in some cases waiting to make a decision can be lethal and no action is the same as making a decision and sometimes it can be the wrong one.

The issue the article brings up a widely heated debate surrounding ER visits for the uninsured. We see this very frequently at the particular facility I am employed by.  What the author fails to mention are possible reasons for this other than "perhaps they still preferred the immediacy of the ER to waiting for an office appointment with a physician." I believe the problem is more indepth. Attempts to insure and place the patients on medicaid may work for a fraction of the population - but let us analyze the population. The particular assemblage in question is made up of those at the lower end of the income bracket. Generally these people are made up of people who are uneducated or under-educated, when the government wants to suddenly insure and place people on medicaid there is education that needs to go along with this change? Education needs to be provided at a level that ensures understanding for this population - otherwise the said population is more confused than ever.  When statistics are reflecting that ER visits have actually gone up since insuring a percentage of this population, is it being taken into account the rise and fall of unemployment? A habit is often created after a certain period of time and continued practice of a new behavior - has there been time allowed for it to become a habit to no longer frequent the ER and instead utilize insurance and making physician appointments? There would be people continually on either end of the spectrum utilizing insurance - those newly placed and those who obtained insured status months or even years from the time the study was conducted that states "...in a randomized study, Oregon recently found that when the uninsured were put on Medicaid, they increased their ER usage by 40 percent." Oregon does not constitute the entire nation. It seems apparent the author is attempting to sway his target audience (those against insuring the unisured and those who are undecided) that medicaid and insuring those previously uninsured is not a solution and has not been effective in reducing ER usage for this portion of the population.

On the issue of the federal government forcing doctors to convert to electronic health records and that this will "..save zillions" - this is true and false - and in writing this article I'm not sure where the author came up with "zillions" as a quotable, factual or believable figure. Employing "scribes", as they are called, and as one can imagine (at a mediocre salary at best) is far less expensive, in the long run, than having a highly-educated and well paid MD performing the mindless task of data-entry. Are "scribes" having to be employed due to EHS mandates? Yes, and at a cost, but far less than the alternative.

Over-all I would state that the view points of the author leave much to be desired. I would have appreciated a more indepth article, especially given the author's background in medicine. I believe this article was to reinforce right-wing perceptions that insuring the uninsured, preventative health-care, and mandated reforms are all unnecessary and to persuade those undecided to the right.