Wednesday, March 10, 2004

I had not planned on posting anything today with the resident service, a lunchtime trauma talk, and trying to come up with a QA plan for the use of FAST exams at big hospital. But when I saw what Mr. Holt had on his site today my "day of blogging rest" went right out the window.
Posted today on THCB is an email sent to Mr. Holt by a reader known as "Industry Veteran". "Industry Veteran" has had a few other things posted on Mr. Holt's blog in the past, usually about pharma issues. While DB and Dr. Rangel can understand the frustration that can lead to a site such as DoctorsKnow, they make principled arguments, which I understand, that the site as currently promulgated, is more hurtful than helpful, the "Industry Veteran" feels the need to, shall I say, make it personal. Since Mr. Holt does not have open comments on his site I feel the need to respond here.

I was sorry to see your statement that you "take the doctors' side" in their battle against the malpractice lawyers. Among those who deserve blame for the shortcomings and inequities in this country's two-tier healthcare system, organized medicine is at least as blameworthy as hospitals, Big Pharma and insurance companies. Although you back away from this ill-considered partisanship in subsequent sentences, your initial sentiment reveals a reflexive simpatico that you should try to eradicate.....All the participants have historically sought to dip their beaks in the public's blood and, in the case of healthcare, the providers have enacted the Tony Soprano role to an extent equalling that of manufacturers and payers.

So while Mr.Lambe of Texas Watch describes physicians as engaging in"pure thuggery", the "Industry Veteran" compares physicians to a fictional Mafia kingpin who cheats on his wife. Moving along.....

Paul Starr's Social Transformation of American Medicine and other monographs have described the tactics that organized medicine used to elevate medical practice from a middling, lower-middle class occupation at the start of the 20th century (when the requirement for admission to Harvard's medical school consisted of the ability to read and write) into the significant holder of gross domestic product that it is today. "In the physicians' view," according to Starr, "the competitive market represented a threat not only to their incomes, but also to their status and autonomy...and threatened to turn them into mere employees."

I have not read Mr. Starr's book (but I plan to) and cannot comment on that particular part of the paragraph above. But I wonder if the "Industry Veteran" would like to be treated by a physician whose main qualification was that they were literate? So much of medicine and medical education has changed since that time due to such things as technology and the Flexner report. In those days the hospital was not where you went for treatment, but went to die.

While increasing a profession's exposure to tort liability is rarely the sole means of reforming public policy, I believe that in this case malpractice actions do help to advance the process. Dragging physicians into the dock furthers the demystification and dissipates the profession's unchallenged self-judgment, both of which permit physicians to insert economic bottlenecks into healthcare while making the provider sector a two-caste system.

How do malpractice actions advance that process? Most of the "economic bottlenecks" I come into contact with from day-to-day are manufactured by the insurance companies and the government.

Other positive functions of malpractice activity include making medicine less attractive to the spoiled princes (and, increasingly, princesses) of American society

How? Other than to provide incentive for the children of current physicians not to go into medicine. I certainly was not a "spoiled prince". Neither of my parents graduated from college, my father was a small business owner and my mother was a part-time realtor. Medical school and the practice of medicine is to hard work for a "spoiled" individual to stick with it very long. If you want to make easy money, medicine is not the place to do it. I can't think of another profession were its practicioners are expected to render service without any promise of compensation, where every customer is a potential litigant, and attempts to secure payment for services rendered is viewed as unseemly when compared to other similar professions. (lawyers, for example)

Certainly I agree with your contention that the necessary process of knocking physicians from their pedestal can be abetted by the increased use of physician extenders (I prefer the term used by labor historians: "de-skilling") and the enforcement of evidence-based logarithms to constrain self-indulgent, self-dealing, cost escalating "autonomy." Despite the nervous handwringing from some of your fellow bloggers, I also want to advance the feminization (more accurately, the "mom-ification") of medicine to deter avaricious ambition from the profession (keep the Jeff Skillings and the Billy Tauzins in business and politics where they belong) while making it more hospitable to the needs of 9-5, live-and-let-live employees

I wish to point out to "Industry Veteran" that you get what you pay for, and I don't mean from a monetary standpoint. Apparently "Industry Veteran" wishes to live in a world where physicians are cookbook following, time-card punching automatons who have been largely supplanted by "physician extenders". Would "Industry Veteran" want themselves or a family member treated by a 9-to-5 physician? "Oh sorry you're having chest pain, but its five o'clock you know, time to punch out." This line of reasoning is much the same as those who want the practice of medicine to be treated like any other job, but recoil in horror when physicians themselves want to go along with that worldview. Then they wail, "You can't do that, health care is different from everything else....everyone has a right to medical care.....if you don't then you will be a thuggish violator of your Hippocratic Oath!" Physicians as people are many things, but stupid usually isn't one of them. The practice of medicine is still special to me and most other physicians, if it loses that luster, many of the best and brightest will move on to something else.

And lastly from "Industry Veteran":

I think we can proceed through a long, tedious dialogue on this issue, and we'd probably conclude with more agreement than disagreement. I don't wish to engage in such a colloquoy, and would instead urge a way for you to expunge your reflexive sympathy for physicians. Instead of maintaining the preconscious image of a workaday British physician such as your father, think instead of the two-dollar whores who demand that the pharmaceutical companies entice them to breach fiduciary responsibilities to patients.

I have just given a long, tedious monologue on this issue. Most of the surgeons I know are workaday (and workanight) physicians and are not, "two-dollar whores". I'm not that cheap of a date. While I disagree with the positions that "Industry Veteran" takes on these issues, many others agree with them. However, most of those individuals are able to express those opinions and debate them without resorting to describing physicians as Mafiosi, spoiled princes, or prostitutes. Is there a corollary of Godwin's Law that would apply? Got to go.
Weblog Commenting and Trackback by HaloScan.com

This page is powered by Blogger. Isn't yours?