Epidemic of Medical Care

Dr Welch in his NY Times article points out that screening for thyroid cancer leads to more diagnosis but not likely better treatment or better care, but likely harms. 

I think it is very interesting as I think about these questions:

1.  What does a country look like that has too few doctors?  I was recently in Liberia, where the WHO registered 51 doctors for the country of over 4 million persons.  Several of those have died of Ebola.  I worked with facilities in Monrovia, where patients are cared for, babies delivered, simple treatments done by nurses mostly.  Research has shown that having a medical attendant for a delivery dramatically reduces maternal deaths. 

2.  What does a country look like that has too many doctors? This is where Dr Welch and the Lown Institute and the Dartmouth research helps us to understand that so much of our medical care is actually hurting us because of over-medicalization, over-treatment, over-testing, and certainly overspending on healthcare in America. 

In both situations--Liberia and the USA--one thing that strikes me is how invisible this issue seems in the regular everyday life of the people and the thinking of the medical workers.  The Liberian government, even today in the days of the Ebola crisis, still will ponder over your application for a medical license.   Providers wonder if a volunteer doctor will be unfair competition.  As if there was not an absolute desperate need.  And in America, new medical schools are still opening, with a call for more doctors in a "national shortage."  The fish does not notice the water she swims in.

And so it takes certain people, with a special vision, to help the rest to understand that realities of the medical establishment perhaps are different than we think.