Tuesday, January 11, 2011

Tucson Truths, the Health System, and Health Reform

Some truths come out of the tragedy in Tucson.

One of these, largely overlooked, is the excellence of our health system at its highest levels, in this case the performance of the trauma unit and its doctors at the University Medical Center in Tucson. When it comes to treating trauma, which happens all too often in America, U.S. doctors are very, very good. We handle acute care magnificently in this country and are not given enough credit.

Sadly, much of this expertise comes from doctors who perfected their skills as military doctors in our current wars. Two neurosurgeons from Washington, D.C, with vast experience in treating brain trauma in Iraqi and Afghanistan war victims , have been flown in to assist Dr. Michael Lemore, head of neurosurgery a the Tucson Medical Center, in evaluating Congresswoman Gabrielle Giffords.

As Colonel John Holcomb, commander of the U. S. Army Institute of Surgical Research, remarked in 2007,

"Things come from civilian medicine, and then we take it into the cauldron of the war and focus it, test it and evaluate it, and then use it many, many, many more times than the civilians have. And then whatever spits out in the end is better.”

Holcomb went on to observe that if one were to eliminate violence and accidents from the statistics, the U.S. ranks at the top in longevity. Holcomb said trauma leads all diseases in terms of life-years lost, more than heart disease or cancer. That’s a useful statistic to keep in mind when comparing national health systems. If one takes trauma and violence into consideration, U.S. longevity statistics are comparable to any other country.

Another truth is that civilian trauma and deaths are largely beyond the health system’s reach. Doctors cannot control what goes on in the mean streets, whether it be in Tucson or Harlem.

Trauma care is reactive rather than proactive. Its excellence comes from experience - from treating many cases quickly. Its best results depend on a quick actions from emergency response teams outside the hospital, upon receiving trauma victims quickly, who have been stabilized at the scene of accidents and domestic and random violence. There are limits to what health reform can do to prevent homicides and accidents.

It is, of course, true that systematic societal approaches banning guns and assault weapons, wearing seat belts, and indentifying drunk drivers and taking them off the roads, would lessen trauma. But these steps are not something the medical profession can control.

We cannot control random acts of violence committed by angry or psychotic individuals outside mainstream civil society. We can diagnose these individuals, treat them, and report them to authorities, but we cannot always predict or prevent what they might do. These persons live in their own mental worlds, and they will do what their demons tell them to do.

We can deplore partisan rhetoric and a“ climate of hate.” We can pray the Tucson tragedy will dampen the rhetoric. But that does not mean fiery rhetoric alone inflamed the mind of the Tucson killer and led him to do what he did. What happened in Phoenix happened because it was the random act of a deranged individual, not because of what the rest of us did or said.

There may be some truths here for health reform. We may be able to reform our health system, but it quite another matter to reform individual behavior or to blame that behavior on society at large. The Tucson tragedy, in other words, is not our fault.

Health reform and soothing rhetoric will not prevent random acts of violence. There are no easy answers here.


Anonymous said...

Since the focus here is Medinnovation and trauma, I just want to comment that telemedicine can play a big role here. We are involved in the telemedicine system developed by famed Texas trauma surgeon, James 'Red' Duke Jr. Studies in process now show assessments and support with a trauma surgeon 'virtually' at the scene can make a major difference. See: http://www.lifebot.us.com

Roger Heath

Richard L. Reece, MD said...

Thank you for your comments."Red" Duke Jr. deserves al the credit he gets and deserves. I will recommend all my readers visit lifebot. us.com