I am writing in response to Cinda Becker's July 12 article, "Specialty cardiac hospitals treating less ill patients". I guess we must remind our readership that hospitals are communal goods, and that if "specialty hospitals" siphon off all the "routine" cases for patient convenience, not to mention often-obscene profits, general and academic medical centers will be left with the most complicated patients, who are the most costly.
Specialty hospitals are both more convenient for patients and clinicians, and tuned to the era of diagnosis-related groups (DRGs). DRGs, as a concept, were generated to "average out" the "simple" and the "complex" clinical cases, to obviate the hedging of degrees of complexity, which is so subjective. Collecting the same reimbursement for all "simple" cases at specialty hospitals means more money for less work, less worrying, perhaps less caring -- meaning "caring for" a patient rather than "taking care of" a patient.
A historian once said "Civilizations are judged by how they treat their most vulnerable, unfortunate members." Unfettered, specialty hospitals will contribute to the undoing of societal benevolent care by making complex care totally unaffordable while well-patient practitioners reap their short-term rewards. The balancing of distributed justice versus autonomy has long been debated in our society. It would seem that specialty hospitals are the perfect embodiment of autonomy at work, society at large be damned. The flip side of this issue seems to accelerate the survival of the fittest historical model.
Claude Poliakoff, M.D., general surgeon, Colorado Springs, Colo.