Wednesday, September 7, 2011

What this is all about....

I am a retired surgeon.  Do I miss the practice of medicine?  I miss something that doesn't exist anymore.  What we have now is Corporate Medicine.  Think about it....if you are a pregnant woman today in urban America, you have less than a 50% chance your baby will be delivered by your obstetrician; if you are about to undergo an operation on your heart - lung - intestine - bladder - ovary - you have approximately a 0% chance of having your stitches removed by your surgeon. If you are hospitalized, there is a very good chance you will be cared for by a hospitalist.  Hospitalists are physicians employed by hospitals. They frequently work 12-hour shifts and are often limited by local regulation to three 12 hour shifts a week.  This means it will take 5 different doctors to cover the 14 shifts in a 7 day period. Think of the chances for confusion and misinterpretation of information as the patient is handed off from one physician to another.  Shift mentality has also taken over the practice of out patient medical care.  Call your doctor after 5pm or at the weekend or on a holiday - the chances your call will be returned by your doctor are estimated to be on average less than 1 in 4!  This is corporate medicine at work - the managed care organization; the physician organization; the hospital-run organization; all balancing the clinical and financial aspects of medicine, and not necessarily for the patient's advantage.
The cottage industry of medical practice, where the doctor-patient relationship was the cornerstone of the medical care establishment, no longer exists.  Health care - formerly know as medical care - is now a technologically complex sector of our economy accounting for close to 20% of our GDP.  The explosive growth of the health care industry - with diagnostic testing that can cost thousands of dollars, procedures that can cost tens of thousands of dollars, and courses of medications costing hundreds of thousands of dollars - has severely compromised and undermined the integrity of the doctor-patient relationship.
The claim that we have the best medical care system in the world is not surprising - we spend more per capita on medical care than any other country.  While it is true there is the potential to get the best care in the world here, for a significant number of Americans this care is not available or accessible.  Our infant and maternal mortality rates are not even close to the top of the list among nations    
and an investigation carried out by the Hearst media corporation in 2009 reported there were about 200,000 deaths attributable to preventable medical mistakes and infections These are just two indices of less than best care.
The primary policy driver for medical insurance companies is cost.  I have read the Affordable Care Act, commonly referred to as Obamacare, and I am concerned that a mechanism for extending that same bottom-line consideration will be inserted into government funded medical care under the guise of quality of life indices.  These practices have yet to be defined, but many members of congress have not even read this legislation or examined its intended and potential unintended consequences.
My point is that the practice of medicine has been contaminated by policies that are not in the patient's best interest.  There are good - better - best approaches to the care of the sick.  I am going to write about what you can do to ensure you find the right provider, learn what your options are, and select the appropriate approach to get the best outcome when you have to deal with our health care system; as well as major issues confronting our health care system today.

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