After watching the final moments of the Chilean mine rescue last night, I was impressed by the amount of patience exhibited by all involved with the ordeal. It took 69 long days to evaluate the situation, assess the most dire needs, and formulate a plan to keep the victims alive until the point of rescue. Once commenced, the rescue would have to be done slowly and safely, despite the anticipation of the crowds and media. What would have happened if the mine was exploded in a brazen effort to dig up the miners? Most certainly, the miners would have been buried forever. What would have happened if the rescue tube was yanked up expeditiously? The cable would snap, and the tube would plummet almost a half-mile back into the depths of the earth. Though not the quickest, last night's rescue will be remembered as the safest and most miraculous in history.
What about patient rescues? Should all patient encounters be performed as quickly as an ER trauma or life-flighted victim in shock? As medical students, we are trained to perform physical exams in 15 minutes or less, pressured to elicit a detailed history in rapid-fire. A novice desperately auscultating for an ejection click or a bruit is unlikely to find it in the 3 minutes set aside for cardiac examination out of those 15. Patients are conveyor-belted through vital signs, insurance forms, physical exams, and deposited outside with a prescription in hand. Is this medicine? Or is it crowd control?
I fear for the future of healthcare. I believe that Obama's healthcare changes will put more emphasis on efficiency rather than quality care. The shortage of healthcare professionals will be pressured to see more patients with less resources available, possibly missing crucial signs and symptoms. Can we still save lives with so little time to work? I can hardly imagine Hippocrates keeping an eye on a sundial as he examined a patient, or Osler advising his rounding medical students to speed up the patient's history because there were simply too many patients to visit. Physicians need time to process the data received, to think through the pathophysiology of the disease presentation. Occam's razor may apply in the majority of cases, but lives may be cost adhering strictly to it, and discounting other possibilities because the history is too long-winded, or because the diagnostic tests are too expensive. The speeding healthcare train must be slowed before it runs out of track. There should be no consequence for taking time to perform one's job properly.
Great post! :)
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