Sunday, January 25, 2009

Limits of intervention, emergecny rooms Listen to This ER Doctor

In seeking to fix our health system, we sometimes forget to listen to doctors on the frontlines, where the rubber hits the road. No set of doctors has more experience in the trenches than emergency room doctors.

One ER doctor, Robert L. Martensen, 62, who now directs the NIH office of history, gives his view of health reform in a new book, A Life Worth Living, a Doctor’s Reflects on Illness in a High-Tech Era (Straus and Giroux).

Dr. Martensen doesn’t believe electronic medical records, though valuable in their own right, will repair the system where patients, doctors, and hospital administrators are unhappy. The problem is a people, systems, and cultural problem – not a technology problem.

Martensen comments there is no center anymore in our atomized system of special interest groups, all scrambling for advantage. This jockeying for position and profit is not something technology will fix.

Martensen is down on Americans’ attitudes towards death and dying, lack of palliative care, and excess money spent on high tech on our last illnesses. He thinks doctors, patients, hospitals, nursing homes, and society at large should get real about death. He believes doctors should read more history and literature. We rely too much on machines to ward off the inevitable. We should, in short, consider dismounting from our high tech horses to focus on human comfort.

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