first, do no harm

Why do people want to be doctors, or rather, what is the primary motivation for someone who wants to be a doctor? I've been wondering about this for a while now. It seems to me that originally, people wanted to be doctors because they wanted to help people. It was their avocation or their talent. Then, to be a healer or dentist or doctor was just another calling, like being a farmer or blacksmith or storekeeper, and they lived modestly like the rest of the population. Doctors were not originally revered as demi-gods. Somewhere along the line, some shift in attitude took place.

In the 50s and 60s and even 70s, doctors were revered and never ever questioned. Their standard of living started to rise above the general population and being a doctor became one of the triumvirate of American professions...doctor, lawyer, engineer. In the 80s and 90s this trend continued. Of course, being one of the highest paid professionals means that you charge a lot for your services.

I understand that part of what drives the cost of medical care is the cost of an education especially with the specialization that is rampant today, malpractice insurance because even doctors make mistakes and modern medical equipment. However, I also think greed has become a major part of what the bottom line is. Doctors are no longer regular people. They have managed to convince themselves and the nation that they are deserving of special treatment, that they should be at the top of the highest paid income list because they 'save lives'. Well, so does a welder who just does his unsung job to the best of his ability. What makes doctors so special? When did being a doctor become the path to riches?

Explain to me why this is justified...

A little girl falls and bonks her chin and gets a 1/2” cut and is sent to the emergency room by the authorities at the church summer day camp where she was when she fell. She is there for about an hour. The hospital emergency room charges $1200 and the plastic surgeon on call charges $800 for the less than 5 minutes it takes him to squeeze the cut closed and apply super glue.

A man wakes up in the middle of the night in such pain in his lower back and abdomen he can hardly move. He is taken to the emergency room where x-rays are taken. He is seriously constipated. The doctor comes in spends less than 10 minutes, asks one or two questions about the pain, does not so much as lay a finger on him much less do any doctoring. Because of the insistence of his wife, he is finally given something for the pain. They decide to leave when the pain subsides somewhat and no further help is forthcoming and as they are being discharged, one of the nurses sees that the doctor (who left at shift change) did not proscribe anything for his seriously clogged up bowels and she went and got him the stuff they give you when you are preparing for a colonoscopy. The hospital charged $775 for 2 hours and the doctor charged $530.

A man, who does not have health insurance, has his hand ripped open by a hidden rusty fishhook on a wilderness canoe camping trip and by the time the trip is over and he returns home his hand is swollen and infected with red streaks creeping up his arm. He goes to the emergency room and every one who looks at it agrees that it needs to be lanced. They give him a prescription for antibiotics, some pain medication, a tetanus shot and discharge him. The next day he goes to a doctor who agrees it needs to be lanced and refers him to another doctor. This second doctor agrees it needs to be lanced but because the man has no insurance, the doctor refuses to treat him even though he has enough money in a savings account to pay for the procedure. He is referred to the county hospital for indigents. After spending nearly 12 hours at the county hospital emergency room where the intern agreed that it needed to be lanced and several times called the on-call doctor who never showed up, the man was finally given two prescriptions for the strongest antibiotics available and discharged. Total bill was about $7000.

A doctor who is content with the negotiated fees from an insurance company is not content with charging the same fee to a self pay patient. They get charged double or triple.

Doctors are refusing new patients if their insurance is Medicare.

I know there are good doctors out there, ones who donate their time and services to give free medical care to those in need. I know there are good doctors out there who will adjust their fees lower for self pay patients. I know there are good doctors out there who do truly want to help those in need instead of using them to pay for their second vacation home or their yacht or their fancy sports car. I know they are out there but they are a vanishing breed.

So, addressing the first part of the Hippocratic Oath, first do no harm, isn't refusing to treat patients doing harm?