08/20/2009 05:12 am ET Updated May 25, 2011

Healthcare Reform... "All Bleeding Stops Eventually"

Healthcare reform is as vital to our nation's survival as is correcting the economic recession. The current state of US healthcare is critical and may prove fatal to our way of life if not comprehensively addressed.

In surgery we have a time honored expression -- "all bleeding stops eventually" -- which means either quickly and decisively take steps to address the pertinent issues or watch the patient die. Doing nothing or delaying is an option but either course mandates a death sentence for your patient.

I agree with the concept of a public option. I agree with President Obama's 8 stated healthcare objectives. I agree with a 1/3 of a percentage point increase in the Medicare payroll tax to fund the program. But what has not been addressed is the need for tort reform and managing the healthcare expectations of American citizens.

A significant portion of the healthcare dollar is spent/wasted on testing and procedures to protect the caregiver and hospital from overzealous lawyers. These tests and procedures are not necessary to properly care for the patient. They are routinely ordered and performed to assuage the fear that one day in the future your actions may be second guessed and scrutinized out of context.

Mal-occurrence is far more likely than malpractice. Gross malpractice is unacceptable. But mal-occurrence is a part of life. Despite everyone's best efforts and good intentions the outcome may be far less than desired. Gross and egregious malpractice should be compensated within reason but mal-occurrence should not.

Also, the potential for enormous jury verdicts and the costs associated with defending frivolous lawsuit have driven the price of malpractice insurance to unimaginable levels, if obtainable at all. The costs associated with caring for insured, poorly insured and uninsured people has made the business of healthcare unsustainable for the physician, the hospital and the ultimate payor (be it the insurance carrier or the government).

At some point, the unrealistic expectations of US patients need to be addressed. Americans are under the misconception that just because they want it or saw it advertised on TV they are entitled to it regardless of the cost.

Patients routinely walk into my office (and every other physician's) demanding unnecessary, un-indicated, expensive testing and diagnostic imaging (MRI, PET scans etc...). A vast percentage of their visit is wasted arguing about the appropriateness or medical necessity of their demand. Many times they ultimately storm out of the office in a huff muttering that they will not pay the bill, what a terrible doctor I am and that they will find a better doctor that will honor their request. Unfortunately, many practitioners acquiesce in a misguided attempt to maintain the relationship, appease the patient and get through their long day without further conflict.

Last but not least, some very sobering facts need to be openly discussed. 90 cents of every healthcare dollar are spent in the last 10% of life. As a nation, can we afford this going forward? Is this a reasonable expenditure of finite resources? To provide basic healthcare for every American citizen we must re-allocate funds. This will require a significant change in the manner in which we care for the elderly and others in the twilight of their lives.

The US healthcare system cannot be all things to and for all people. We simply can't afford it.

Without meaningfully addressing tort reform and patients expectations the probability of significant monetary savings and improvement in the all important quality of care is a lost cause.

The concept of service to community starts now. We must all give and make compromises for the health of our nation. Please remember that if we delay or fail to act..."all bleeding stops eventually".