The health care debate

One morning, at the breakfast table, while eating a bowl of Fruity Pebbles, your chest begins to hurt. The pain worsens and you feel breathless. You briefly consider the possibility that what you’re eating really are pebbles.

Being the cautious person that you are, you call 911. Our EMS team arrives, and then transports you to the clinic where tests are done, medications are given and your chest pain goes away. Next you are put on a helicopter and flown to the hospital where you are thoroughly tortured with very, clean devices. The tests turn out to be ok and you are sent home. Are you safe? Well that depends upon what you mean by safe.

Emergency rooms across the nation have a “miss rate” for heart attacks of about 2.5 to 5 percent. If the emergency room doctors fail to discover your heart condition, you may be released prematurely to finish your heart attack at your next bowl of Pebbles. You would think that something as dramatic as a heart attack would be easy to find. but it isn’t so. Heart attacks result from a clot in one of the arteries that deliver blood to the heart. The largest coronary artery is tiny and buried deep within the chest behind skin, fat, ribs, and muscle. If a clot happens, it can cause any one of a myriad of symptoms such as chest pain or arm pain.

Internal organs speak to doctors in strange languages. A gallbladder can sound like a stomach and a stomach can sound like a heart. The question to answer is always, “Which giblet is it?” The emergency physician must determine whether such symptoms are actually attributable to a tiny clot, the size of a match head, and way down deep in the chest. They can’t see the clot and although many tests can be performed, none of them are perfect. The PTCA (percutaneous coronary angiogram) is about as good as you can get. A small tube is threaded from a large vein in your crotch all the way up to your heart.

Dye is injected through the tube into the coronary arteries allowing the doctor to take x-ray pictures of them arteries and find the blockage. It is the best test we have, but it has risks and is very expensive.

So how safe do you want to be? Finding and treating 80% of a given disease is usually pretty easy. The next 10% is much harder and more costly and each percentage point after that even more so. It is theoretically possible to find every heart attack, but at what cost and risk?

The point is while we are in the bloody fray of the health care debate, we need to ask, “Should I be eating Fruity Pebbles?”