By Patrick Wagner, MD
The fundamental job of the doctor is to understand normal, to understand disease, to understand the therapy needed to rid the patient of the disease, and finally to render treatment. Happily, treatment works! That makes doctors happy. With these basic principles in mind, it is time for us all to become the doctors of our sick health care system. By doing so, we will again be happy.
There are many diseases we don’t have cures for, but we are making inroads. I think of the future of medicine and surgery and am inspired by the same thoughts you are inspired by. Will we actually be able to cure cancer? Will we be able to cure paralysis? Will we be able to regenerate the pancreas and cure type 1 diabetes mellitus? Will we be able to define the short circuits in thinking pathways in the brain and engineer medications to overcome mental illness? Will we be able to give sight to the blind? The list goes on.
We must also think back and recognize how far medicine has come. Amazing things are here for all of us today. A young woman in labor has the option of an epidural catheter to ease her delivery. A cardiac surgeon has the skill to replace a human heart! The plastic surgeon can reshape the upper lip and base of the nose to help a growing youngster with a cleft palate. Young patients with cystic fibrosis are treated by their dedicated doctors and breathe for as long and as comfortably as possible, surviving even beyond middle age. Trauma and critical care surgeons can restore health in extensively injured car crash victims. We must never take these things for granted.
If we stand back for just a minute, take a deep breath, and think about it, we will recognize that medicine is vitally important to all of us. We all want to be well, and if we get sick we want to get well. We anticipate that the doctor will be there for us. We anticipate that the doctor has morals and follows the Hippocratic Oath. And rightly so. We can feel the goodwill.
I have written two articles that were printed in this news magazine. They highlight my experience in managed care. As discussed in those articles, managed care is a process whereby the people who run Medicare and the people who run health insurance companies took over the responsibility of managing our health care. Based on the observations I made as a surgeon during my career, I believe that managed care went into full swing in about 1992. Therefore, we are two decades into managed care today. What I was told when managed care began was that I was charging people too much money for my services. It was time to decrease the cost of rendering medical services. I was also told that I must strive to increase the quality of my services. Those were the same things you were told by the people and organizations who developed Medicare and managed care, and whom you pay to administer those services you receive. I strongly sense that hospitals were told the very things that I was told, namely to decrease their costs and increase their quality of services. I base this assumption on the change in the relationship I had with the hospitals in Sacramento in the latter part of my career. This change broke my heart.
I don’t think the noble goals of those who devised managed care and Medicare are being achieved. We’ve been at this for 20 years. From my perspective, there is massive confusion out there about what’s going on. There is an urgency to solve the problems confronting us all. I also believe that we are in complete control of how we are to continue. No meaningful progress can ensue without our hard work, wishes and wisdom; not Medicare, not managed care, nothing. Not even goodwill. Sadly, the depersonalization of managed care took goodwill for granted. The loss of goodwill among doctors and patients was an unintended consequence of this past 20 years, truly not anticipated by those who took over the administration of our health care.
I believe that for this problem to end there is no option left for us other than to talk honestly to each other in a peaceful environment, listening and sharing our ideas and opinions and our questions. I am overwhelmingly optimistic because of who I am writing to right now. Why therefore, I appeal to everyone reading this article is to speak up, to share your opinion, to ask questions and to expect answers. I appeal to you to talk to each other, especially those who don’t care about health care. Find out who these folks are. Gently confront them and get them to talk. These are the people about whom I am--and everyone else should be--most concerned.
What better way to begin this conversation than a forum or a town hall. I think it is crucial for physicians to show up and contribute. It is their opportunity, their responsibility, their oath, their duty to speak up! I’m no author, but I am a problem solver—just like all other physicians. I do believe that other doctors should share their thoughts about health care with the public. Physicians, I appeal to you to let yourselves be heard. You’ve got a captive, non-threatening audience. Don’t be afraid to talk, for you are among friends. Don’t be afraid of the health insurance payer anymore, because we have the power to pay the health insurance payer or not! Boldness will not necessarily lead us to political suicide; fixing our crumbling system should be our number one priority. We are all concerned about who will care for us and our loved ones when it’s our turn to get sick, and we need to determine an answer to this question. Managed care has proven it won’t be the answer we need.
What we do or don’t do is going to direct the future of health care in this great country. We all know this is the truth. I’ve been told that we will get what we deserve, and the American people deserve a lot. Now, it is time to get to work to ensure that what we get is a system of health care worthy of our people.
Patrick Wagner, MD is a retired general surgeon, making his home in Nevada City.