> I respectfully dissent: To me it is a money issue and there is no art.
> It is (or should be, I believe) simply a matter of arithmetic. We
> should agree on how much we can afford to spend, and then use the
> dollars where we get the greatest return. What art is there to saving
> one life (or case of deafness or whatever) at a cost of $X, when that
> same $X could have saved two others elsewhere?
I rarely reply to this list, but this above paragraph just really burned
my back side.
So, becuase Child 1 has one type of, oh hell lets say cancer, and Child 2
and 3 have another type, are you aluding to forgo aggressive treatment or
management of Child 1's cancer because you can treat #'s 2 and 3 for the
same or lesser cost?
If this is the correct inturrpertation of this, then please do let me know
just where it is you pratice at so I can make sure I dont move there in
the future. Heaven forbid should one of my 3, or any child I throw in the
back of my ambulance come down with something.
> The "art" (to me) is an excuse for not having (or else ignoring) the
> data. The only logical way to practice is to come up with some cut-off
> (sort of like Oregon's plan, but more evidence-based) in terms of
> badness prevented per dollar. We need to know the probabilities that
> admitting a generally well-appearing patient with a given pleiocytosis
> will save bad things, and then simply see if the cost of admission is
> below or above the cut-off.
Hmm, I would have assumed that the only logical means of proceeding would
be to allow the physically attending Dr. to base thier decisions upon
thier pt's presentation and thier Dx instead of having to make thier
decision based upon a phone call to a HMO provider who's only interest is
seeing that thier CEO's pocket is lined with at least a 8 figure number
[log in to unmask] IRC Admin LasVegas.NV.US.Undernet.org
Grant me the ability to give Emergency Care. With skillfull hands, and
knowledgeable mind, and tender love and care. Help me deal with
everything, when lives are on the line. To see the worst, administer aid,
and ease a worried mind. So help me as I go today, accept what fate may
be. Touch these hands, use this mind, help this EMT...Amen
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