Texas Medicine Letters: January 2013



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Letters – January 2013 

Indivisible Questions Arise  

When I was serving as vice speaker and speaker of the Texas Medical Association House of Delegates, it was my job to determine if a resolution with two or more parts could be divided and voted on separately.

Occasionally, there would be a request from the floor to "divide the question." That is always honored unless the parts are inextricably connected, such as approving an action and approving the funding for that action. 

Changes in public opinion and health policy are creating indivisible questions that were once divisible. Whether appropriate or not, in many arenas health care is now considered to be a "right." Unlike rights such as life, liberty, and pursuit of happiness, this right must be created by funding or by confiscation of the service from the providers.

Taxpayers have funded health care for longer than the entire career of almost everyone currently in practice, at the local (hospital district), state (Medicaid), and federal (Medicare) level, and taxpayers heretofore have been somewhat restrained in dictating how health care is delivered. 

However, with the rise in the cost of health care, there are new attempts to assert control by both the financier (taxpayer) and its agent (government) in areas that were previously considered privileged.

Thus, we have already had consideration of laws in parts of the country to demand an ultrasound before an abortion, to require HIV testing in laboring mothers who have no previous prenatal care, and to dictate how large a serving of soda can be sold.  

As the publicly funded portion of health care enlarges, and certainly as it becomes a right, we can expect these assertions to become more frequent and more robust. We should anticipate possible further attempts to regulate diet, exercise, infectious disease status, age-eligibility of treatments, and safe-discharge criteria.

The right to health care cannot easily be divided from its funding, and the funding cannot easily be divided from fiscal oversight, even when such oversight is intrusive.     

TMA and other organs of organized medicine must be prepared to discuss these questions as they arise, no matter how difficult – and possibly even distasteful – such may be.

These questions will be asked and decided, and for this to occur without physicians' input will put our patients' rights and safety at risk.

Stephen L. Brotherton, MD 
Fort Worth
TMA President-Elect


Hard Hats for Horseback Riders  

 

I am always delighted to see articles about the importance of helmets and safety, especially with regard to TMA's Hard Hats for Little Heads program. (See "Preventing Injury," October 2012 Texas Medicine, pages 35-39.) What has always puzzled me, however, is the lack of mention of riding helmets for horseback riding.

 According to the 2007 National Electronic Injury Surveillance System data, there were more than 78,000 horseback riding-related injuries reported in U.S. emergency rooms, with head injuries comprising 15 percent of these. Given that Texas has approximately 1 million horses, the most of any state, it seems some mention should be made about horseback riding and the role helmets certified by the American Society for Testing and Materials (ASTM) can play in the protection against head injuries, especially for children. 

As an avid rider myself, it always concerns me to see anyone atop a horse without proper head protection, given that their heads are potentially 13 feet or so above ground. Riding an animal with emotions and prey instincts puts anyone at risk of an adverse event, but especially our children who may not be able to anticipate a problem. 

The website www.Riders4Helmets.com is an excellent resource for information and education about the importance of wearing an ASTM-certified helmet while riding. Let's embrace our equine heritage and our role as the leading horse state in the country by including horseback riding in the push for greater helmet awareness and use! 

Caren C. Reaves, MD 
Denton


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