COMMENTARY

Medicine Can't Ignore Baltimore and Ferguson

John Mandrola

Disclosures

May 01, 2015

The 2015 Quality of Care and Outcomes Research (QCOR) section of the American Heart Association focuses on what works, what does not work, and what things cost. This sort of research is vital—now more than ever. We must know value. Benefits do not stand alone; they must be weighed against cost.

Unfortunately, the QCOR meeting was canceled because social unrest in Baltimore made it unsafe for researchers to gather together in an American city.

Could there be a more vivid example that doctors don't practice in a vacuum? We are connected to this world—whether we like it or not.

You could make the argument that riots in Baltimore (and Ferguson) don't have any bearing on medical practice. You could say these matters are about police behavior and racial tension, hardly medical issues.

You would also be correct to say that practicing doctors cannot alone solve the imbalance of opportunity that so ails our society.

But we can stop making it worse.

In the singular, doctors exert little influence over society, but imagine what we can do together. Together, we have an immense collective power to serve the greater good.

The real (or upstream) reason QCOR was canceled is the growing gap between the people who have and those who have not. And it is not just in cities. In Scott County, Indiana, an HIV crisis due to intravenous drug use has transformed a quaint picturesque area into what looks like a third-world country. Needles on the street. Gaunt people walking around in a daze. Hoosiers afraid of strangers.

While much of America discusses mobile health, Apple Watches, and the next iteration of electronic health records, other humans struggle to get the basics—food, water, shelter, and basic medical care.

My mind jumps immediately to stewardship. It is something every one of us in medicine can influence.

Healthcare spending represents a huge drain on this nation's resources. We burn money in healthcare. The waste is painful. It hurts my heart. Expensive drugs because pharma reps bring burritos, pacemakers for vasovagal syncope, ICDs for death prolongation, AF ablation in the overserved, and so much more. And this: why does cardiology ignore the COURAGE trial[1]?

Doctors don't control everything in medicine, but we play a large part in determining what is spent. We control the narrative, spin the story, and can easily create fear. Then we order the tests, prescribe the medication, and do the procedures. Too often, we fail to tell patients about their disease trajectory. Many of us forget the advice of the famous physician who practiced in Baltimore. Dr William Osler taught that we need to treat people, rather than just diseases.

We burn money in these disease silos.

Call me a progressive or redistributionist if you must. But taken together, the sum of all this waste adds up to possibilities.

Recently, I saw two patients in the office who make my point. One was a wealthy man who had a benign arrhythmia, a malady brought on by the lavishness of his life. He had undergone medical tests and procedures that tallied into the tens of thousands of dollars. He took expensive medicines. None of it necessary. It was waste. It was like watering your lawn during a drought.

The next patient I saw did not speak English. She looked hungry and wore distress on her face. She had a medical problem that I could fix. But here was the kicker: she would not have had this medical problem if she had had access to basic healthcare. What was worse: I had to wrestle with the healthcare machine to do what was basic and just.

The difference was stark. It made me mad.

If I had a public-health blog it would be titled: Stop burning money!

JMM

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