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How Sprained Ankles Can Lead To Cancer Drug Rationing

New York Times blogger Tara Parker Pope describes how her daughter was recently “the victim” of excessive medical investigation. Apparently, the little girl twisted her ankle at dance camp and experienced a slower than normal recovery. Four weeks out from the sprain, Tara sought the help of a specialist rather than returning to her pediatrician. The resulting MRI led to blood testing, which led to more testing, and more specialist input, etc. until the costs had spiraled out of control – not that Tara cared much because (as she admits) “I had lost track because it was all covered by insurance.”

Instead of any twinge of guilt on the part of Ms. Pope for having single-handedly called in the cavalry for an ankle sprain, she concluded that her daughter was a victim of medical over-investigation. But what would any physician do in the face of a concerned pseudo-celebrity parent (with a huge platform from which to complain about her medical treatment)? The doctor would leave no stone unturned, so as to protect herself from accusations of “missing a diagnosis” or being insufficiently concerned about the ankle sprain.

The responses to Ms. Pope’s personal “horror story” about over-treatment (and the waste of billions of dollars inherent in the US medical system) were amusing. One commenter writes, “Why not think of the unnecessary $210 billion as a fiscal ‘stimulus?’ Makes as much sense as any other program in the Age of Obama/Krugman.” And another, “[Of course there's over-treatment] because the federal government subsidizes it! Medicaid, Medicare, and third party private insurance all promote the use of wasteful health care spending. And Obamacare will put that process on steroids.”

Whether or not you agree that socialized medicine reduces healthcare costs, it seems to me that we all have a responsibility not to over-utilize medical resources so that they will still be there when we really need them. Over-investigating every pediatric ankle sprain will simply drain our collective resources, ultimately resulting in further healthcare rationing. New York Times writer Peter Singer has argued that rationing is inevitable and decisions about cancer drug treatment will become the purview of US government agencies as time goes on. I’m pretty sure he’s right.

That being the case, why spur on rationing? Ms. Pope’s victim mentality demonstrates her lack of insight into the true causes of rising healthcare costs – one of which is patient demand. Ms. Pope herself is contributing to the healthcare waste she despises by requesting excessive testing in an environment where physicians are afraid to say no due to legal pressures (or a NYT writer’s bully pulpit). Demand drives costs, and there is a finite limit on our resources. Personal responsibility must play a role in healthcare utilization, just as efforts to protect our environment and scarce resources require participation by individuals. Ultimately, one child’s ankle investigation comes at the price of another patient’s cancer treatment.

Was it the physicians’ responsibility to put the brakes on her daughter’s over-testing? Maybe, but I’d prefer to live in a world where patients can invoke additional testing when their personal judgment suggests that it’s important. Ms. Pope knew better, but requested the additional testing because her insurance paid for it. Free care leads to more care – especially more unnecessary care. Ms. Pope’s daughter was not a victim of over-testing, but a beneficiary of that luxury that may soon evaporate.

We can create a healthcare system where no ankle gets more than a physical exam and ibuprofen (so we can forcibly prevent over-utilization), or we can teach people to use healthcare resources responsibly. Unfortunately, that will require that patients have a little more financial skin in the game – as Ms. Pope has demonstrated. The alternative, a distant oversight body regulating what you can and can’t have access to in healthcare, is where we’ll probably end up. Some day in the future Ms. Pope will recall the day when she was able to get unlimited medical investigations for her daughter without question or cost, and she’ll marvel at how that freedom has been lost. By that time, I suppose, I’ll be one of those people who is being denied cancer treatment by my government.


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5 Responses to “How Sprained Ankles Can Lead To Cancer Drug Rationing”

  1. Kristen says:

    Why can’t the doctors be more practical/ethical? Why does it always slippery slope to consumerism being the problem. If her doctors were so wise, they’d know that the ankle would just heal with old-fashioned rest. Doctors are in love with their tests. And to blame it on concern for reputation ruin by a loudmouthed patient, that’s a wimpy excuse to enjoy the so-called “stimulus.” What ever happened to ethics?

    As someone who opts out of most medicine and is self-insured, I resent that if I had a broken bone (which I am not equipped to handle at home), it would result in an inflated charge because the system allows others to abuse it. This is not the fault of socialized medicine. The current capitalist system is doing just fine on its own keeping costs high.

  2. edward gluckmann, m.s. says:

    She has a column that once started with an introduction that the column was designed to help people make decisions that would put them in charge of their wellness and health. That introduction rarely was honored as it is easy to succumb to the myths and needs to be close to those with M.D. after their names. But her example is just another case of medicine gone wild. The simple facts are 1) medical care received is one of the top five killers in America every year, 2) its expense is unrelated to the costs but more so to income flow and profit, and 3) we live with rationing based on ability to (or have someone else) pay and the emotional and politically driven arguments that other methods of rationing are bogus, communistic, socialistic, unfair etc. are just that bogus.

    In a country where over 45% of the total wealth of this Nation is owned or controlled by 1% of the total population the present non-system of medical care delivery is just fine and dandy. That 1% can pay any price. But rather than offer a solution to this inequity by rationalizing that delivery and supporting alternatives they continue to drop millions into new buildings for medical care delivery and research (which also gets them free care)!

    The author was mesmerized to the present delivery of medical care for years by being close to medical doctors and not too friendly to other healers whose ideas, efforts and actions are downgraded regularly by the established medical schools, medical professors, medical training directors, medical administrators, medical group leaders and the medical profession. But even with all these MEDICAL types the words wellness and health (as in wellness or health center) is still rare.

    The younger population now deprived to a large extent by price to medical care and its underwriter insurance companies are walking with their money to the alternative wellness and health alternatives. We can hope that T—P will get there too.

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Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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