Column by David Reynolds
That is, if you can get an appointment. Or your doctor hasn’t taken early retirement.
Yes, we have a problem, not just up in River City, but in every town in America. We have a doctor problem. Two questions: Do we have enough doctors? And what do doctors think about the president’s health-care plan?
Strange, nobody seems to be asking such questions. Too pointed. We love the broad picture. And with action. That way “Breaking Action News” will have a 20-second story to report.
Maybe the world is right about Americans and our Wild West heritage. At least the president is banking on our inclination to shoot first and ask questions later. That is what the U. S. House of Representatives did just before the witching hour exactly a week after Halloween. It fired a big shot – 1,990 pages big, certainly too much for all 435 members to digest. So the majority had to swallow hard.
Now comes the bad news for the president. The action now swings to the Senate, a slow moving deliberate body. How un-American!
But whether or not this Medical Concorde flies, does it not make sense to consider the supply of doctors? After all, the current ranks of 700,000 active physicians can not adequately treat today’s patients, let alone handle an expansion of insured patients plus all those approaching my age. And the 25,000 young men and women annually putting on new white coats are not enough to close the treatment gap. So what gives?
Of course, we can take a page out of the Japanese medical directory. In Japan the typical doctor-patient relationship lasts for a full seven minutes. Sorry, when the doctor is in, there is no time for chitchat or to explore for a second cause. Just take two aspirins, and call in the morning.
There are other unpleasant facts to consider. By circa 2020, as many as a third of those now practicing medicine will likely retire. Plus an untold number of others may leave because of, let’s call it general dissatisfaction. Too many are becoming so burdened with non-medical work that they have little time to do what they love to do. Was this their dream in med school?
So who can blame doctors for hanging up their stethoscopes early? Last year the Rockbridge community lost a fine general surgeon and an internist. They were at the top of their game. And they managed to dodge all those malpractice-lawsuit bullets. So why not quit? Athletes do it all the time. We cheer them when they do.
Sixteen years ago this month the Washington area also lost a good doctor. He, too, was well regarded by both peers and patients. However, this doctor was more than a physician. He was a close friend. We would lunch and travel together. He would tell me much of what was on his mind, about what it is like being a private physician. But, unfortunately, he did not tell me everything. One evening shortly after our last lunch, Bill drove home from his office. He opened the garage door. It closed. He sat in his car. He kept the motor running.
I could have been a better listener. Are any of us listening to these dedicated men and women who go through so much in order that we have better and longer lives? I know that I failed to hear the anguish of one William Cooper. M.D. doctors, by virtue of their training, are proud individuals. As with those in the military who serve us, duty comes before self. Both witness so much of what they can not speak.
But does that mean we should not try to listen? Since we have an entire nation not listening to doctors, I thought I would pass along what’s on the minds of five doctors. They spoke at a gathering in New York on Oct. 19. Their comments may differ from the doctors who were dazzled with a White House invitation on Oct. 5. That is when the president did most of the talking.
Dr. Jeffery Borer, cardiologist, asked, “What’s the impact of guidelines on the doctor-patient relationship? Guidelines step in between the doctor and the patient.”
Dr. David Fields, ob/gyn, said, “Guidelines are always about average medical care … they tend to cramp the physician who can do better than average. Government is in the process of duplicating everything that managed care did for the last 15 years that was reviled by everybody.”
Dr Joel Kassimir, dermatologist: “We’re being told by physicians advising the president that we take the Hippocratic Oath too seriously.” (And by the AMA, I might add.)
Dr. Richard Amerling, nephrologist: “The successful value surgery I gave an 85-year-old is not going to happen because the government will say that person has outlived her useful years, no matter how long she will live.”
Finally, Dr. Seymour Cohen, oncologist, had this to say, “When we went to medical school, people used to die at 66, 67 and 68. We were the bad guys. Now we’re responsible for keeping people alive to 85. So we’re now going to change health care because people are living too long. It doesn’t make very good sense to me.”
Dr. Cohen, you were not a bad guy. And you are not today, except in the eyes of a few. And, doctor, none of this makes any sense to me either. I know for sure it would not make any sense to my late friend from Washington. Little of what comes out of that place makes sense to me anymore. I’m getting old. I may have outlived my useful years.
Is anyone out there listening?
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