Tuesday, November 9, 2010

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?


  1. Great and thought-provoking post. It makes me wonder about our culture again. I remember talking to Japanese, Portuguese, Mexican, and Latvian doctors. Never got the impression that money was the issue. Never. Hippocrates must be turning over in his grave. EFH

  2. Your posts on healthcare in the States make me gasp in horror. Yours is one of the richest nations on earth, what is wrong with you?

    Somewhere along the line something bad happened to you.

  3. Couldn't have said it better myself. For years we took our girls to an old-school, small town pediatrician. He always had time for us, always gave the best care, and would even make house calls when the girls were sick. He knew us all by name, and he was always interested in what the kids were up to. It was never about money for him.

    He retired a few years ago, so now we go to a clinic in the next town over. We are nothing but a number there. We see a different doctor every time, and none of them know our kids' names. And it usually takes 6 weeks to get an appointment.


  4. Our previous doctor (from before we moved) works really hard & I don't think he was rich - I actually think that the way he has to work with insurance companies has taken all the joy out of medicine for him. He's bound by so many rules & can't really treat people in the manner that he wants to. So, for him, the insurance companies are the great satan.

    So between that & the doctors who are in it for the money - the US healthcare system is a MESS.

  5. Well my friend, you know how I feel about doctors.......great post. Just like manners, common sense and being nice........doctors like people have forgotten and been blinded to what really is important.
    The harm that is done is obscene.
    The Olde Bagg

  6. I second Friko's reaction. I just don't get the resistance to changes to the American health care system. This sort of thing is just unheard of here.

  7. You go girl!!! Those are shameful examples of how everything is becoming driven by capitalism.

  8. I guess when you have more it doesn't matter the care of those who have less - even tho' they have worked hard to have what they do.

    I agree with anyone who says our country is a mess especially when it comes to healthcare.

  9. All I can do is add to the horror that Friko and Hilary have registered. Doctors over here are respected but thank goodness for our National Health system!

  10. Gee. I thought it was "First, take Wednesdays off for golf." Shows what I know.

  11. There are good and bad. We are fortunate that we stumbled upon our doctor here. He only charges what we can afford over his actual cost. I have worked with many doctors and have seen the dedicated ones as well as the ones who want to pad their pockets. Too bad the bad seem to outweigh the good!

  12. I'm not sure that all of the blame can lie with the doctors. Part of it comes from the way our insurance system is set up. And no, the healthcare bill that just got passed will not fix that. I don't know if it would be better to go back to charging what people can actually afford. I feel like that would leave someone behind somewhere. The system is definitely a mess and putting a bandaid on it won't fix anything.

  13. It is a shocking post, Ellen. And it feels more shocking to see these events that are not uncommon, through the eyes of friends who aren't American, like Friko, and imagine their incredulity at such possibilities. No doubt someone could explain how we got here and why it is so difficult to change this system now. I hope that doctors themselves will be the cause for change. I don't know any other effective way. We need more political voices like Dennis Kucinich, who advocates for a healthy diet and lifestyle first and foremost, and education about it, as our primary effort toward health care.

    Have you ever thought about what a strange term "medicine" is? Doctors are taught to treat symptoms with medications. Why not teach us to be healthy people who could avoid many symptoms if only we were attentive to our bodies and minds?

  14. Expat - I constantly wonder about our culture. the richest country in the world doesn't give a hoot about the health of it's citizens. What does it say in the Declaration Of Independence, that we are guaranteed life, liberty and the pursuit of happiness? Isn't health care necessary for life?

    Bug - I actually have a great internist. He spends as much time with you as you need, makes sure he answers any questions you have, treats you like an intelligent human being and is willing to consider alternate forms of medicine and his fees are very reasonable. Here's the thing, he does not do insurance. The patient pays and he gives you whatever paperwork you need to file for your own reimbursement but he does not do it.

    VM - True, the insurance industry has a stranglehold on health care here in this country but doctors are not blameless. They are in fact totally responsible for their actions and inactions in all the cases I cited. And one I forgot to mention. when I was pregnant, in labor, contractions maybe 5 minutes apart I arrived at the hospital and the doctor broke my bag of waters. Not for health reasons but to hurry along my delivery for his own convenience. And I agree that this health care reform bill will not change anything. It certainly won't make the fees more affordable and won't stop the peanut counters for the insurance industry deciding what tests or doctor ordered will be covered. the only good part of it is that they won't be able to deny you for pre-existing conditions but I imagine that right there will drive rates up. So we will end up with mandatory insurance with deductibles so high to make the premiums affordable that insurance will end up not paying for anything. We will be stuck with paying premiums and paying for our medical bills.

    Ruth - this is why I do not really like western medicine because they only treat the symptoms and never address the underlying causes. I think there is plenty of information out there about how to live healthy lives but Americans are, for the most part, lazy and stupid. they want a pill to fix it. I don't see doctors being in the forefront of any change. for that to happen, they would have to care more about doctoring than how much money they can make doing it.

  15. It shouldn't be this way.... Yes, not helping often means doing harm! It's a disgrace!

    I can't really imagine most of the things you describe, at the same time I feel we are moving in that direction... sigh...

  16. You and I are on the same wavelength. I just sent a letter to the "new" congress stating for-profit healthcare is killing our country. Not only does it go against everything doctors are supposed to be - but the pharmacies are doing much of their training! Which of course means, what? Using drugs! Which then leads to more problems and then more drugs. We are broken when it comes to healthcare.

    My father-in-law was an old school doctor - the kind you talk about - humble, never rich, and there to heal, not make an over the top living. He actually talked my husband out of following him into the field for all the reasons you mentioned here.

  17. So many people actually think, as so many doctors think of themselves, that doctors know it all...they follow a doctor's instructions no matter what...they would rather take the poisonous drugs prescribed than change their lifestyle and live healthy...I really dislike the medical society...I hope I stay healthy or I've got a real problem...

  18. Reading this makes me angry. I am surprised that the people of America have put up with this for so long. Canadians are laid back folks but I do think there would be uncontrollable outrage if any attempt was made to change the medical system to one similar to the US. When I first arrived in the UK I heard people complaining about the National Health Service, but in my experience it is brilliant.

    It seems the American health system has somehow become built on bullying, fear mongering and the financial bottom line. Appauling.


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