On the way out of the exam room, after proclaiming her happiness on being cured of a lifelong arrhythmia by a single 4mm radio-frequency ablation lesion, the patient shows me the hospital bill and asks why it costs 39,000 dollars?
Of course, the answer requires a few words.
We are young doctors in training, learning new techniques and struggling with the tactile sensations of the catheter. The professors look on with only a finite patience before they step in. Things improve gradually over months -the learning process is in motion. The era is just after the chapter of the rotary phone, and the IU EP lab has only an xray unit, an analog digital recording system and a bag of pretzels.
A few months before graduation into the real world, engineers from Israel arrive on the scene with a new computer system equipped with a first generation GPS system built into a catheter and a magnet under the table. Larry and Bill–the professors–are excited, but the fellows despair, as now we stand taking points in the chambers of the heart while a three dimensional map is created. The cases drag on for much longer while the map with pretty colors is created. The bright colors illuminate the cardiac electrical system. Before an iphone could ever have been imagined, it seems a miracle of geometry and engineering that a computer can know the catheter tip location and then display it in real time.
Now, many years after the introduction of this science project we cannot imagine doing an ablation procedure without this CARTO 3D mapping system.
The newest CARTO arrives in a huge box big enough to require a pallet. It is the latest and greatest version and will surely simplify our life and make us better navigators of the catheter. A sweep of a catheter in the heart sends out signals and a computer creates an accurate drawing of the chamber. Amazing!
Similar to how a new carbon fibre bicycle calls you to ride and makes you better and faster, maybe, simply because the brain thinks it so, a new mapping system that can see all your catheters, navigate the way, and color the waves of electricity in the heart will boost our ability and desire to doctor. This is good for both us and our patients.
It costs the hospital much, and herein lie some of the complicated themes of healthcare. It is true that healthcare could cost less, but if it did, the box of technology that helps us so, would likely never arrive. These tools that come from Johnson and Johnson are but a small tree in the forest of modern day healthcare. The costs parallel its usefulness and illuminates the growing pains of our amazing abilities to cure.
To the patient, I say, “Ooh that seems expensive.”