The three words in the common surgical adage “all hemorrhaging stops” impart a great deal of medical wisdom. In the best case, it means that the surgeon takes trained and skilled steps to halt the bleeding. To the other extreme, the patient dies, and the hemorrhaging stops as a consequence of inaction or ineffective measures. It is easy to see how one might apply this adage to current governmental action in health care. Yet there is an even more horrific outcome, and that is where the patient/health care system is artificially maintained on life support but intermittently “bled” as we apply political solutions rather than evidence-based public health measures. In that scenario, the hemorrhaging doesn’t stop.
Like many, many other physicians I am hoping the eventual outcome of health care reform has the appearance of a skilled surgical procedure that results in a healthy patient. We may have to wait a long time to find out. The purpose of this piece is really to discuss what medical professionals, as opposed to politicians, are doing and should continue to do in this extended state of uncertainty. There is great opportunity and accomplishment that should be recognized and reinforced so that we continue to make progress on important health care initiatives. It is essential that we maintain our morale, and continue to attract dedicated young people to our profession.
It is clear that currently we do not achieve satisfactory health outcomes for a large part of our population. My area is eye care, and though patients with eye disease don’t bleed to death as in the above analogy, blindness ranks with cancer as the most feared health malady. In conjunction with the Oregon Commission for the Blind, we have just conducted an exhaustive evaluation of visual impairment and legal blindness in Oregon, and the findings are “eye opening.” This study documented that advances in eye care have dramatically improved care for patients with macular degeneration. But, despite advances in treatments for the leading causes of blindness: macular degeneration, diabetes and glaucoma, each year thousands of Oregonians progress to legal blindness. In fact, despite these advances, due to increasing longevity, the incidence of legal blindness in Oregon has increased for each of the past five decades. In addition, childhood blindness represents an increasing percentage of cases of legal blindness.
Regardless of how policy on health care changes, providers of health care need to focus on early detection, timely treatment and medical advances. Progress can occur despite great uncertainty in the funding of health care. For example, through partnership with the Oregon State Elks, we annually screen 7,500 preschool children for eye disease; identifying children with undiagnosed eye problems when they are most amenable to treatment.
The Oregon legislature is to be commended for adopting this same approach for all children entering educational programs. Through the support of Casey Eye Institute donors, we have also developed an adult vision screening program that partners with community organizations throughout the state to identify patients at risk of vision loss from macular degeneration, diabetes and glaucoma. Casey faculty members have developed new diagnostic devices such as optical coherence tomography (performed 30 million times annually) and new treatment modalities such as gene therapy that provide early diagnosis and treatment for some of the most challenging eye diseases.
As our politicians wrestle with the challenges of how to structure our health care system, it is important to recognize how much is being achieved. The combination of early diagnosis, timely intervention and development of new treatments is the same paradigm that is being employed by the OHSU Knight Cancer Institute and other health care institutions throughout Oregon. This approach is successful due to the support of private donors in partnership with government and foundation grants. Creative application of these resources is why almost all of the major advances in health care have originated in the American health care system. It is important that we recognize and reinforce the accomplishments from these partnerships, lest we make the hemorrhaging worse.
David Wilson, M.D., is professor and chair of ophthalmology, OHSU School of Medicine, and director, OHSU Casey Eye Institute.