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From the Editor: Watch Your Buts
Much to the country’s delight/chagrin, we are reforming healthcare. No one is questioning the need to ensure that everyone in the US has access to quality medical care. But what’s the price to insure and why is so much of the burden falling on twenty-somethings who are just starting out and may be the least equipped to pay? No one is casting tea into Boston Harbor with regard to pre-existing conditions. But what about pre-existing pregnancy — ie, abortion — or persons who make unhealthy lifestyle decisions. Should their patent disregard for their own well-being become the nation’s problem? No one wants to deny that children deserve a healthy start or that everyone should have the opportunity to participate in a medical plan that supports wellness and prevention initiatives. The problem is how to contend with the “buts.”
A big “but” for me is to wonder how the country will be able to pay for the new plan; shifting some of the responsibility to individual states that are already all but bankrupt smacks of the lending schemes that crashed our economy into recession. I refuse to be either blatantly opposed to or blindly optimistic about our new healthcare plan — I boarded the hope train in November 2008 and although I haven’t seen much reason to be hopeful since, we can continue to work for change. Plus, when faith in the success of our new healthcare plan seems to depend on which side of the proverbial aisle you sit, I become skeptic-in-chief.
I agree with Vice President Biden — this is a big, f**king deal. My concern is that, similar to many situations in life, we may be more enamored with the idea of health reform than the realities of the bill. It shouldn’t be a matter of just “Git ‘er done.” Never one to play to extremes (I “hid” a lengthy debate raging on my Facebook page), I don’t understand how people can be so certain this plan will or won’t work. What about all the gray areas, the contingencies… the “buts”?
This issue of OWM features several articles that openly address “buts.” Black et al describe tissue types in pressure ulcers; they concede that appearances can be deceptive — ie, it looks like a pressure ulcer with eschar but it is actually an arterial ulcer. Beitz and van Rijswijk re-examine a care algorithm that had been validated but not (until now) for use by the extended cadre of wound care providers. Takahashi et al, finding that research on venous ulceration is available but doesn’t necessarily include the population in whom these ulcers frequently occur, examined risk factors for venous ulcer development in older adults. Carter calls into question evidence-based medicine’s gold standard — the randomized controlled trial. RCTs are worthy tools for assessing a product or approach — they are the ONLY way to confirm efficacy (one product/approach is better than another) — but (as is standard in science) other study designs may be better suited to answer important questions about wound and patient care.
In my opinion, Carter’s most tacit point relevant to healthcare reform, as well as wound care, is that we need information in a format we can apply to patients, who really are an N of one, and ensure that the evidence works with but doesn’t take the place of good clinical judgment. We need to be ever-cognizant of the mitigating factors inherent to providing care. Sweeping reform should not presume to sweep the many remaining issues (the “buts”) away for struggling states and future generations to address. No wound care clinician would dismiss a troublesome ulcer by saying, “Let someone else handle this.” Let’s keep our eyes on (and our heads out of) our “buts”.
Southern skies. The backdrop for
Yearly gatherings and more
Many sessions to attend
Pre- and post-con at each end
Of paths to better patient care
Shared by peers extraordinaire
Inter-mixed with one-on-one
Unplanned, special, just plain fun
May this be your year to achieve
A conference high
You can celieve.
This article was not subject to the Ostomy Wound Management peer-review process.
