There’s the story about a guy who sees all these dying starfish washed up on a beach (why starfish? Probably because the name is cool) and sees a kid pick up a starfish and throw it in the water. “There’s no way you are making a difference,” the guy tells the kid, because he’s apparently a jerk. And the kid says that may be true but he made a difference for that one starfish. Inspirational lesson learned.
Honestly, if you are in healthcare you kind of have to agree with the kid, because if you take a more utilitarian view you’d start advocating for all the dollars spent in the hospital to instead be allocated for buying mosquito nets and antiretrovirals and then you wouldn’t have a job. But the more I think about the story I do kind of feel what the kid was doing was pointless. I am that jerk sometimes.
However, despite the temptation and my cynical tendencies, I am not a utilitarian. So I do have to say that throwing a single starfish back into the ocean makes a difference. (Maybe. Maybe the starfish was already dead. How can you tell? Obviously no experience with starfish here.) Using thousands of dollars of medical care to save the life of someone I’m caring for in the hospital is worthwhile, even when those thousands of dollars could theoretically save many more people in some underprivileged place. But… at some point, does it become too much?
I struggle the most with this not when a saving treatment is really expensive, but when the “saving treatment” seems unlikely to be helpful or that it will have limited benefit. Active ninety-plus year olds choosing they want to be Full Code, when surviving a code situation would likely mean increased debility, dependence, hospitalization and an end to the healthy lifespan: that is hard for me. People with uncontrolled diabetes, end stage renal disease, and terrible blood vessels who cannot care for themselves who choose to go on dialysis for hours three days a week: that is hard for me. Cancer patients who have growing metastatic disease with chemo treatments that are sending them into the hospital every month with essentially zero chance of cure: that is hard for me.
It is a good thing I am not in charge of medical gatekeeping, because I am not God. I do not know what the outcomes of our medical interventions will be, and when I guess I am more than often wrong. I do not know the value of a ninety-two year old living six more months, or a dialysis patient living three more years in a nursing home, or a cancer patient living an extra few weeks in the hospital. Where there’s life, there’s hope, at least from a spiritual perspective.
What I worry about, however, is that we do not have endless resources. Sometimes I joke that it feels like practicing in the hospital is playing with fun money, because I can pretty much order any test I want and have it done, unlike in the outpatient setting. But the truth is, someone is paying for it. I worry that the people paying for it are maybe three years old right now. Will people in the future have more limited access to healthcare because we’ve already spent the money that was supposed to be for them? Will their insurance costs soar because the insurance companies are passing on their costs to the patients? It’s already happening.
Thinking about these things leaves me frustrated, because I don’t have a solution. Maybe my personal solution is I need to be less judgmental about other people’s value judgments regarding their healthcare.
SDG