by Patrick Wagner, MD
In a recent article I wrote about managed care in America, I mentioned that I am a doctor who felt compelled to leave my medical practice a few years ago. After nearly two decades of practicing general surgery in Sacramento, I made the decision to quit medicine, not because I was tired of the work, or even because I wanted to spend my hard-earned money on retirement vacations. In truth, I stopped working as a physician because my career as I knew it had turned into a series of unfavorable decisions. These decisions, however, were not the unfavorable ones I had knowingly signed up for when I originally became a doctor--how to break the bad news to somebody who had cancer, or how to know when to stop resuscitating after a heart refused to resume its beating. These were scenarios I hated but accepted as part of my job.
Unfortunately, the new and unfamiliar daily choices I began making later on in my career, dealt mostly with the question of whether or not to consistently abandon my ETHICAL principles as a doctor.
Let me explain. When I first became a physician, I signed up for a job that demanded not just scientific expertise, or an ability to go days without sleep, but also a critical sense of personal morality. The Hippocratic Oath I swore to, alongside the 31 other new doctors in my graduating medical class, asked each and every one of us to profess: “I will repel any medicine, operation, or advice which is injurious or deleterious to my patients.” After around 30 years of watching healthcare grow and change in America, the moral principles in this oath have remained the same. But the social context surrounding this oath has mutated into something almost unrecognizable. In my wildest dreams, I never would have guessed ETHICS would be the reason I’d eventually stop practicing medicine.
There are many causes for this drastic change in the quality of our healthcare system; a few decades ago, things were quite different than they are now. Folks who are old enough to remember the 60s, 70s, and the early 80s will doubtfully recall any prescription drug ads on TV, the radio, or in print for things like anxiety, sleep problems, birth control, joint pain, high blood pressure, or erectile dysfunction. I’m also willing to bet that people probably don’t remember their health insurance company being such a fundamental part of their overall care. And it’s probably also safe to assume that most people don’t remember ever worrying about a preexisting condition affecting their future medical coverage.
That’s because America didn’t ALLOW these things to occur in the past.
Before the early 80s, “direct-to-consumer advertising,” or the marketing of medicine to patients rather than to medical professionals, was ILLEGAL in the US. This means that since the early 80s, prescription drugs have been advertised to us in our homes like any other consumer product--paper towels, chewing gum, soft drinks, garden fertilizer. It’s also important for Americans to understand that our country is one of only two nations in the entire WORLD that allow this type of advertising to occur. Lawmakers in all other countries see this type of marketing as unethical and potentially dangerous to consumers.
In addition, the private sector has infiltrated the health insurance industry throughout the past few decades in a way we’ve never seen before. Big business has transformed health insurance companies from “non-profit” or “mutual form” organizations into “for-profit” institutions, which function exclusively to make money for their owners. Why is our care as patients being denied? Why are there so many rules about what we do and don’t “qualify” for when it comes to medical coverage? It’s because somebody’s making a buck as a result of all these dangerous cut-corners. And that somebody is certainly NOT you or me.
And unfortunately, the most crucial piece of this whole mess of a medical puzzle--the one piece that could put a stop to all of the injustice Americans face as patients and family members of patients--is currently failing us. Our own government must REGULATE problems like pharmaceutical company influence on the medical profession, and insurance company fraud. Our government must put a stop to all of the unethical activities that take place within our healthcare system--activities that would be considered ABSURD in any other industry of our market economy. Can you conceive of any other normal, functioning, American business “legally” refusing to perform a task or produce a product it was paid to render? Me neither.
So, why are these drug and insurance companies able to get away with the things they do? Because our country has not set responsible RESTRICTIONS before them to place American citizens before profit. Politicians have given doctors and patients alike a backseat to the bigwig medical lobbyists who influence their legislative and voting decisions. Our judicial system PROTECTS these companies rather than the Americans they “serve.” In fact, folks who get health insurance through their employer (more than 100,000,000 Americans) are even PROHIBITED by federal law from taking these insurance companies to court if they encounter any shifty or unfair transactions.
To make a long story short, the medical profession is no longer in the hands of people who understand, or even work in, medicine. And for years, the patients who medical professionals have worked to serve have been slowly steered away from quality care by a Middle Man that cares more about wallets than wellbeing. The trust Americans used to place in their doctors, nurses, and hospitals has diminished, and in the place of that trust, anger has brewed.
I am here to tell you that doctors feel that anger too.
Sadly, the anger I felt, and my daily memory of the Hippocratic Oath, urged me to walk away from the “medicine, operations and advice” that I saw as deeply “injurious [and] deleterious to my patients.” This Oath also demands that doctors affirm: “In deep conscience, I will practice in full awareness of my limitations of mind and body in order to follow that therapy that’s best for my patients.” This therapy is not best determined by pharmaceutical sales representatives. It is not best determined by political lobbyists. And it is certainly not best determined by health insurance agents. On the contrary, it IS best determined by countless American medical professionals who have dedicated their education, training, and life’s work to patients who need help and empathy.
The only way to fix our sorely abused and degraded system is to take authoritative power away from executives who aim to make money, and place it back into the hands of those who matter most in healthcare: patients and medical professionals.
This change will not occur overnight. And it will not magically happen by “socializing” our healthcare system. Socialized medicine means nothing unless it’s administered properly, and the corruption in our current system would surely prevent socialized medicine from achieving many of the changes Americans wish to see.
The fact is Americans need to build an awareness of who’s actually in charge of our pocketbooks, our future sense of security, our priceless bodies. We must begin to “ask our doctor” about his or her perspective of insurance profiteering rather than just Paxil® or Previcid®. We must always remember that our health is endlessly more important than an insurance company’s annual surplus or a politician’s next campaign. We also cannot forget that there are other Americans who are bothered by these atrocities, and that in numbers, we can take back the system that’s rightfully ours.
The good news? If anybody can take down Goliath, it’s surely a bunch of majorly irritated TRUTH KNOWING Americans. There’s no doubt that in trusting others to manage our health, we’ve been duped and taken for granted. But now, it’s our job to begin asking some serious ethical questions and to start using our knowledge of the truth to demand that our healthcare system change for the better.
Patrick Wagner, MD is a retired general surgeon, making his home in Nevada City.