Monday, 22 October 2012

A Crooked Middle Finger Salute

I Solute Your Irrational Meme

Why did my broken middle finger heal crooked in this highly touted single-payer (aka socialist) healthcare system? The answer to that is both really simple and also highly nuanced and complex. The simple answer is that the orthopedic surgeon, you know the bone specialist who trained for an extra 5 years to get really good at mending bones, did the wrong thing.

The level of inquiry I find most people engaging in on matters like this is superficial and leads to an unsatisfactory and childish answer, “That’s a bad doctor.” I don't buy that explanation, I think that after 13 years of medical training this orthopedic surgeon knows how to properly mend a broken finger. The question is why didn't he do what he knew to be the best treatment for my middle finger?

I was told by both the ER Physician and the orthopedic technician that I would require a pin to be put in my finger. Imagine my relief when the specialist said he'd just straighten it out and splint it in place and see me in 3 surgery necessary. He told me what I was hoping to hear, that everything would be ok without having to go through an invasive procedure. Now I have a crooked middle finger and the things that I love to do -play guitar and piano, hold my spouses hand- will never be the same.

I don't think anybody can accurately answer why the doc didn't do the right thing but let me take a stab at some plausible answers.

1) The payoff to put in the pins wasn't enough. In order to put in pins he would have to book an OR room have staff prepped, provided he could even get an OR room on short notice. He would have to arrange a schedule and make time. What he would get in return would be seeing fewer patients, making less money, and having more work backed up when he was done with me.

2) He was overwhelmed with patients. The day I had my consult with him there were 50 other patients waiting to see him that morning. I can’t imagine spending several hours of his week dealing with a broken finger would be at the top of his priority list.

The rational thing for an orthopedic surgeon to do given these conditions is to look for the quickest way to deal with my finger, it would be irrational to take the time to do surgery when something else might fix it reasonably. This is just a small personal tip of the iceberg glimpse of system that incentivizes mediocre and crappy health care.

Lets set aside the fact that as a double income family in Fort McMurray my spouse and I pay over $30,000 in health insurance (that’s the portion of income tax that goes to health care), that the government enforced monopoly on healthcare drives the cost way up, and that licensing and regulatory environment make it difficult for healers to set-up shop. It is illegal for me to find and pay for a specialist in Alberta to spend some extra time with me making sure I’ll be able to play the guitar again. If I did find an orthopedic surgeon who was willing to accept payment from me to fix my finger he would risk losing his practice.

I don’t really blame the physicians, heck I don’t even really blame the legislators for this they are only doing what people want them to do…they are acting rationally to keep their jobs. If I had to blame anybody I’d probably place it on the people who vote and say things like, “they oughta do…x”. These people in aggregate form the base of legitimacy for an irrational and immoral system where threat of violence is the organizing force. Please be aware that your irrational beliefs result in real physical harm to others.