Thursday, February 25, 2010

Speaking of hope and change

There is a reason I am a physician, not an attorney or clergy. I have often wondered but I believe it is because my vocation best fits my personality. I am usually too outspoken to be the latter and not enough to be the former. Thinking about my chosen profession on a day when the leaders of our country are trying come to some type of consensus on an equatable way to deliver health care in this country has caused me to reflect on the words: "hope" and "change."

This has also given me pause to reflect on the two words I believe are most critical in this health care debate: "greed" and "apathy."

Two years ago I had a great deal of hope that we would see change in the way health care is delivered in this country. My passion for this has pitted me against many of my colleagues. One of the biggest reasons I left private practice was the unmitigated greed I saw medical practice. This included everything from unnecessary testing to generate income for the profit centers in the practice to poor medical practice in allowing minimally certified office staff to preform triage functions including ordering and reviewing medical tests when the physician was not present, allowing that physician to bill for services preformed when he/she was out of the office. The reasoning given for doing this was the same one I use with my mother when I was in junior high school. "Everyone else it doing it."

Lest you think physicians are the only greedy ones, hospitals and insurance companies are right there and they make a bigger impact on health care costs than physicians. Without naming names I challenge you to look at some of the publicly traded health care companies from health insurance, physician groups, and hospital corporations. Or better yet, go and look at how your local nonprofit hospital is set up. You may find many for profit arms protruding from the altruistic body. These for profit connections receive money from the non profit base and they are owned by the officers, board members, and physicians, who are employed by or practice at these institutions.

Like the cardiologist once explained to my father, then in his 70s and only taking a baby aspirin daily, "We have a huge industrial-medical complex here and we need to get you to participate more to keep it running."

Which brings me to apathy. The employed and retired American public that by and large has health insurance is very apathetic when it comes to helping those who do not. If you are over 65, you probably have Medicare and many in this age group also have gap policies provided by their former employers. (Look at your TEA Party groups and you will find those who maybe taxed enough already but they are also happily getting their health care from a younger generation's tax dollars while many in that younger group are going without health care coverage.) Those who are too sick to work, disabled, or self employed know how difficult and expensive it is to obtain health insurance. Having always been self employed, I have always been aware of the cost of health insurance. With tort reform, I now pay more for health insurance than I do for liability coverage.

And there is patient apathy. For example we all want heart health achieved by prescription drugs, brand name at that, not the self care and work which is required to eat a healthy diet and participate in daily exercise.

I could go on but I will stop here. I remember as a child being told the only person I have the power to change is myself. I continue to work on this and yes, even my attitude after a year of this health care debate. I will also keep on talking with patients about contraception, diet, exercise, and sexually transmitted diseases because I have hope that some will listen and begin to change.
Speaking of hope and changeSocialTwist Tell-a-Friend


reverendmother said...

I'm so thankful for you and your testimony!

local MD said...

Thank you for your comment,RM. It made my day.

Anonymous said...

As an attorney, I think you would have made a great counselor of law. As a fellow Presbyterian, I think you would make a great reverend. But you're probably right about picking the right profession because you were the best doctor I've ever had, and you're deeply missed by your former patients - we talk. In any event, being a member of the legal profession and a member of the church, I think you would probably be just as disenchanted there.

local MD said...

Anonymous, please know that I miss the patients I had to leave. The only tears I shed were over difficult of leaving those of you I served. As my accountant was constantly pointing out, I am not a business person. Apparently that is what it takes to survive in private practice, the ability to think "this is just business" and walk away.