When I was an intern and resident in the 1980s our mantra was "leave no stone unturned." This meant to us that we should consider every possibility for the cause of the illness that plagued our patient and should do every test, try every possible treatment, and consult every specialist as long as it would help us best take care of our patient.
We would look out at the "field of stones" and know that we could actually turn them all over and best treat our sick patients.
Then in the 1990s the "field" changed. Because of the new technologies we had CT scans, MRIs, and PET scans. There were other tests including new genetic testing, better and more sophisticated chemical testing, and better and easier ways to biopsy abnormalities.
In the 1990s as we looked over the "field of stones" it became evident that there were too many "stones" to be able to turn them all over, and we had to select which ones had the highest probability of finding a result that would help our patients.
We also knew that under each unturned "stone" there rested an attorney waiting to pounce on the opportunity if we were wrong.
Then came the 2000s when insurance companies began restricting the "stones" we could turn over with pre-authorizations or outright denials, and uninsured patients could not afford the tests at all. Those "stones" turned into "boulders."
Now as we looked over the "field" there was an endless terrain of "stones and boulders," and the amount of time allotted to turning "stones" or trying to push over "boulders" was not enough to accomplish the task, and we became tired.
In the upcoming decade as we look over the "field" the task seems daunting. What can happen to make the caring for our patients easier and less costly? What can we do to see fewer "boulders" and more "stones"? Is it tort reform? Is it government or private insurance?
Can we afford to increase health care expenditure from 15 percent of GDP to 30 percent as our society ages? Can we in our "faithless society" get people to understand that costly terminal care is in fact futile?
The difficult decisions about the fate of health care in America lies in the hands of people who are ill equipped to understand the issues that face us.
This is not a Democrat or Republican issue. It is not a young or old issue. It is not a rich or poor issue. This is an issue of the fate of our health care, and I believe that should lie in the hands of those of us who have provided that care. But that is clearly not going to happen.
Alas, I understand that in September of 2009 my calling is to return to the "field" where I will turn over "stones" and "boulders" as long as I can, and then hope that as I transition from a health care provider to a health care recipient that there will still be doctors willing to turn over those "stones" and "boulders" for me.
Richard Ameen, M.D.
Spotsylvania