An Unwanted Variation in American Medicine

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One of the things reformers point to most frequently is the wasteful variation in medical practice. They do not understand why certain common diagnoses are handled differently by different providers. They have a good point. There is more variation that there needs to be, and more than is good for the patient.

Certain drugs have been shown to work effectively in an acute heart attack. Certain procedures are associated with faster recoveries, less complications and better heart function. Clinicians should be using these techniques which are well-documented in what is called “the literature,” data collected and reported, based on research and experience.

Of course, treating patients is not like baking cakes. You don’t get out a cookbook, whip up a recipe for recovery and watch the patient automatically get well. Patients are not rum babas, and critical care units are not bakeries.  That said, there is considerable room for improvement in American clinical practice, and electronic health records will help us get there.

But there is another variation in medicine that clinicians have no control over, and that is the variation in laws and practices that exist from state to state. A heart attack in Nevada is exactly the same as it would be in Maine. Laws regarding standards of practice should be the same from state to state. A Medicaid patient is Nevada should have the same prospects of recovery as a patient in Maine, and Alaska, and Texas, and Montana.

Life should begin at the same time from state to state. Spouses should have the same visiting rights from state to state. Children should be granted the same medical protections. Pregnancy should be treated the same. End-of-Life ethics should be the same. It should be the individual that matters, not state law.

The only reason this unreasonably decentralized system exists is because the authors of the Constitution did not address medical matters so that means it falls to the individual states. That probably did not provoke as much of a problem when doctors only had blood-letting and a few herbs to offer the sick. Now letting each state manage its own health care is a major problem. Diseases do not vary from state to state, only politics do, and that is not good for patients in 2012.

We need more efforts to bridge this problem. More organizations working cooperatively to come up with national standards. Further reform can move us toward this. Is there a doctor in the House?

Tom Godfrey

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