Page 65 - Just Deserts

TotalCare

completely implicit—triage. Without it, given the range of costly life-
support equipment available today, we would have a situation
disastrous for our resources. This is because in our society, in a non-
wartime situation, the worst cases may not be ignored; heroic
measures may, in fact, be required just to keep them alive, much less
healed.”
“It works like this: our doctors cannot or will not send every
patient presenting ambiguous clinical symptoms for a complete
battery of tests; the cost would break his budget. Those who demand
them may have to be satisfied, but, as the figures show, they are in
the minority. Of the rest, it may be assumed that many will get better
with no treatment, with standard prescriptions for known diseases
conforming in some respects to the symptoms, or even with a
placebo. But a few do in fact have a much more serious problem
which, because it was not discovered, will be deadly. Of those, some
will return with their condition so advanced that nothing can be done
except give pain-killers; others will die before they can return for an
appointment; only a very small number will end up with the
expensive treatment we are required to provide, and which a private
physician would have prescribed earlier on.”
Dr. Bellarian stood up and walked to a cabinet on one side of his
office. A trephined skull rested atop it, just about at eye level with the
Chief.
“Very interesting analysis, Ms. Collins. An implicit triage, you say?
But none of our personnel can be accused of violating the rules, is
that right? It must be purely coincidental that this statistical anomaly
fits so perfectly with budget requirements. But this does not help
TotalCare run more efficiently, does it? How can I use your
information to reduce our overhead?”
She shrugged. “I’m not sure; you’re the doctor, Chief. An
interesting aspect of my audit is the ‘what-if’ capability of the
software. By plotting the cost per terminally or seriously ill patient
who returns after a misdiagnosis against total departmental costs, it is
possible to find a break-even point beyond which our doctors could
begin to reduce their expenses below their allotment. Here: I printed
out a few detailed graphs for specific diseases as well as a composite
picture. You can see the large impact a small number of cases has on
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