The Quiet Epidemic

• Desired action: prescribe colchicine for acute gout

• Reason unable to perform desired action: insurer will not approve

• Alternative action: nothing; advised patient about possibility of increased flares

This quote is from this week’s “A Piece of my Mind” in JAMA. The article continues:

“It seems the effort to protest and fight the regulations has worn us down, and in one generation, physicians have gone from being advocates for their patients to gatekeepers for health care practices that may be cost saving for the system but may feel heartless and tragic to the individual patient. The sentinel events we face every day should be the raison d’être of a system. Each instance of this craziness is off the radar screen: a silent epidemic.”

“This has been the best and worst of times for our profession. New diseases and their pathophysiology have been elucidated, but the existence of some, such as chronic Lyme disease, are contested, and some physicians treat with therapies that have proven to be useless.“

“The world, at times, seems to have gone mad with senseless (at least from a clinical point of view) administrative rules. We have new powerful agents for gout and hyperuricemia, but colchicine, a highly efficacious drug used for gout since 1500 BC, is no longer readily available in Veterans Affairs hospitals (VAHs) because the cost has gone from 50 cents to more than 3 dollars a tablet.”

In another passage, the authors say:

“House staff are better rested, but their attending physicians are more anxious, as the fundamentals have taken a back seat.”

“It is clear that something has to change to facilitate patient care and address physicians’ helplessness to perform our jobs to the best of our ability.”

The authors’ proposal is to use classic research methods in order to collect the evidence to prove their theory that healthcare administration often stands in the way of delivering good care:

“The goal of accumulating the data is to aggregate these sentinel events so that the signal of administrative interference with the ability to provide good health care is both clear and compelling, providing the information necessary for a change in the system and possibly its conceptual framework. It would allow detection of an epidemic of damaging administrative decisions and, like all epidemiologic surveillance data, illuminate areas for detailed analysis.”

via The Quiet Epidemic, November 2, 2011, Chang and Liang 306 (17): 1843 — JAMA.