Gabrielle Giffords, the U.S. Representative who was shot in Tuscon, went home recently. It’s a heart-wrenching story, and all of us wish we could wave a magic wand and restore her to her previous level of vitality. However, once again the press took an opportunity to take an individual’s circumstance and use it to foster a broader discussion, but instead merely proceeded to give us more GIMeC blather.
A reporter for the Houston Chronicle quoted Giffords’ chief of staff as saying “I’ve got an up-close-and-personal understanding now of how speech and physical and occupational rehab really makes a difference, and I just can’t imagine a patient in a similar position who wouldn’t be able to receive the care because an insurance company would argue that it’s not needed.” Her chief of staff is apparently also an expert on the natural history of recovery from traumatic brain injury and the evidence for rehabilitation therapies. The story went on to estimate that therapy where she stayed cost about $8,000 a day. Six days at this place is roughly equal to the median household income in the U.S. (corrected from earlier post)
I also remember a TV reporter interviewing one of the doctors at this Houston facility talking about how they used shopping carts as therapy, because it was a familiar activity for many of the patients. You can buy a lot of shopping carts for $8,000 I suspect, though I haven’t actually priced them.
The reporter included a little civic drum-beating by declaring her treatment in Houston to be “world-class.” If a car company or phone service claimed to have the best product, the reporter wouldn’t state that without facts to support the claim. So often in medical stories, the reporter doesn’t bother to fact check, and just accepts the “expert’s” opinion, even if the expert is selling the reported service. The Chronicle reporter, Mr. Shauk, is probably just proud to be a Houstonian.
The humble truth is that 90+% of the final health status of the patient is determined by the original injury. Minor brain injury leads to nearly full recovery, major brain injury leads to a significantly a different health state from the pre-injury status. There is evidence that early rehabilitation improves outcomes, but the results are often statistically significant, but subtle and subjective. As a society, we shouldn’t promote $8,000 a day rehab without solid evidence that it is much better than much cheaper alternatives.
As a family doctor I see first hand what is left over after the actue episode occurs. My lady in Jan 08 had a massive stroke. She pulled through but now lives in a nursing home and is unable to take care of her self.