"Molière saw through the doctors, but he had to call them in just the
same."
"It is not reasonable, to expect doctors
in private practice to be impartial when confronted by a strong pecuniary
interest."
George
Bernard Shaw
As one who has had either the fortune or misfortune of being
a personal injury litigator, depending on one's altruism or lack thereof for
over 43 years, I have reached some inevitable conclusions concerning the individuals
who could stand the sight of blood
and therefore embarked upon a course of deriving a benefit from the maladies of
others.
How this exalted professional status has struck social
observers over the years varies with the intensity of their individual
experiences. George Bernard Shaw's
outlook was somewhat malign toward the medical profession, observing that, in
the "Doctor's Dilemma,"
"...when doctors as competitive tradesmen
were replaced by a medical profession that had been brought under responsible
and effective public control. Until this body of men and women were
"trained and paid by the country to keep the country in health it will
remain what it is at present: a conspiracy to exploit popular credulity and
human suffering".
In other words, Shaw was looking forward to the
creation of a National Health Service." These words were written in 1903.
Not that lawyers are not calculating; however,
they are constrained by the law and by their profession itself to simply
presiding over the transfer of wealth from one party to another, providing the
oil for the cogs of either justice or of criminality to function or not. Many are just as greedy as anyone else,
but generally, people's lives do not depend upon their behavior. Their fortunes, yes, their freedom,
often, but, except in rare criminal cases, not their lives.
Much of the angst that Doctors suffer,
depending upon their conscience, individual character, or profit motive, fear
of being sued, or other governmental intrusion upon their fiefdoms depends upon
how motivated they are by greed. Often the ones who are greedy usually occupy
large private medical groups and are judged within that group by how many
patients they see, or how much revenue they generate. Usually the ones affiliated with Universities and are
academics are somewhat less motivated by such obsessions. Some doctors are so greedy that they
refuse to write prescriptions for patients who do not come in for a visit at
which time they can be prescribed almost anything they want, as long as the
doctor can bill either Medicare or a private insurer for an office visit. If a patient calls and asks for a
renewal, the doctor insists that they visit or get no prescription, blaming the
government in most cases, of non-esistent governmental scrutiny. Some will not even fill out a form
without a fee being charged to the patient. Patients resemble a stack of Benjamin Franklins to them.
Questions concerning such matters with the
doctor often evokes an aggressive, "find another doctor" rebuke. Such an enormous ego or insecurity
does nothing for the doctor-patient relationship. One doctor was offended by my asking for test results after
waiting 10 days. No concern for
the patient's anxiety evident at all. "That's normal for this office, if
we are not meeting your needs, find another doctor."
In addition, my individual experiences with
doctors who testify in court enjoy more popularity if they are the most
convincing witness no matter the mendacity of their testimony. Some doctors who specialize in forensic
medicine, charge highly extravagant fees, based upon the rationalization of
loss of net patient visits when they are obliged to visit the courthouse or to
give deposition testimony. Every
fundamental lesson of cross-examination of these doctors requires questions of
how much they are paid for their testimony, what percentage of their practice
is dedicated to treating patients, and how often they are in court (often more
than in the office) and for which side they testify, how many patients they
actually treat, etc.
Some have robotic administrative staffs specifically geared
to make sure the doctor is or will be paid before
he or she even consents to treat a suffering patient. They have
insufferable office managers trusting no one, their jobs set by the culture of
the office promulgated by the greedy doctor rather than the needs of the
patient, affirming the 1903 Shaw philosophy that doctors should be working for
a National Health Service. Illness
should not be profit driven and insurance companies whose motives to collect
premiums and not pay claims remain insidious affronts to a decent society. The same rule should apply to
physicians who run their offices as though they were branches of the Bank of
America.
Some argue that health care needs physicians
profit motivated to make decisions concerning the patient's health and that it
attracts people of quality to this profession. Studies in European nations like Sweden debunk this notion. Compounding this error is the health
insurance industry, stories about which circumlocutions to a avoid legitimate
claims are often featured by investigative reporters and on "60
Minutes."
Doctors who seek fabulous wealth should be in
business, not clinicians; they deserve to earn a good living commensurate with
their hard work and training. But
a profit motive for a clinician simply works to the detriment of the
patient. And a profit for a health
insurance company is the same evil on steroids.
No possibility of great change in this system
is possible unless the public is disabused of the notion that clinical medicine
is a business. Clinicians perform
great service to society, but usually perform no research and development. If they do, they are entitled to
patents for their work.
Then they can reap the rewards of
entrepreneurship. Otherwise,
let them earn a good salary, live in a nice home and stop acting like they do
not belong to a noble profession, dedicated to their patients, and not to large
boats and McMansions. Leave that
to the titans of industry, or as Theodore Roosevelt aptly put it, to the
"Malefactors of Great Wealth."
No comments:
Post a Comment