Walls
By Pat Racimora on June 3, 2009 at 3:30 PM in Health Care
Marcus Welby? He’s history. So says Ronald Glasser in a stinging Washington Post editorial. It’s not that a Dr. Welby won’t be coming to your house because he doesn’t care to do that sort of thing any more. Your doctor is no longer available because your doctor is probably no longer in control of what he and she does!
Here is a shocking fact.
Of the 15,000 students who will graduate from medical school this year — and the roughly 8,000 physicians and surgeons who will finish their specialty training — more than 93 percent will become employees of large clinics, managed-care companies or hospital systems.
Yikes. 93% of newly available doctors go directly to “The Man.” What does this mean to us, I shudder to ask?
These physicians … are no longer patient advocates. In many ways, they’ve abandoned the patient to the work rules of health plans and the professional demands of managed care. The Hippocratic Oath has been discarded, and the Golden Rule has become: He who has the gold sets the rules.
What this means is that the care you get — and how long you get it — is only the care your health plan will reimburse your doctor for. You can see your psychiatrist or psychologist for five visits; you can stay in the hospital for 48 hours following a hip replacement, or three days after a radical prostatectomy. Simple mastectomies go home the same day, and gall-bladder removals as soon as they wake up from the anesthesia. If the drug prescribed is not on your health plan’s list, then your doctor will have to prescribe an approved alternative that may not be as effective.
So why don’t doctors care about this? Dr. Glasser continues:
Everyone in medicine knows that these are no longer the physician’s patients. They belong to the insurance companies, the health plans, the hospitals. With that understanding comes personal indifference and professional exhaustion.
Dr. Glasser goes on to assert that even medical training is complicit in separating doctors and their patients. Small group practices are dismissed as unworkable, and “team playing” in large practices is taught in its place. He concludes:
Perhaps we can’t go back to the two- or four-physician group practice. But medical school faculties can quit carrying the water for the managed-care companies and the large hospital systems. Our current medical system is out of whack. And those of us who see the edge of the cliff approaching should begin to warn publicly that medicine cannot survive if its real value — its capacity both to comfort and to heal — is replaced only by the superficial value of price.
Now I realize how lucky I am. I have a primary care physician who is part of a husband and wife team practice. No walls! They do ask for quarterly checkups and do a lot of prevention counseling. I do have to pay extra for all of this because this level of individualized care is not covered by my insurance. What I didn’t realize until I read Dr. Glasser’s article is that, for most people, even paying extra for this level of care is not an option. However, even my doctors are getting older, and when they retire I do not expect to find a replacement.
by Ronald Scott
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