We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Thirty years ago, the training and practice of medicine was deeply rooted in "inherited" values as much as craft. Physicians were in a noble discipline recast into paladins protecting society, even a bit of its soul, against an implacable adversary. Training was both arduous and flawed (inflated egos and autocratic mice that roared) but with a central purpose. When done well, doctors successfully confronted their most difficult internal challenges, fear of the power of illness and the willfulness to make important decisions when the consequence was uncertain. This "old" medical culture was best expressed by a single term: "My patient." It was as far from provider and client as you could possibly get. "My patient" conveyed both bond and responsibility.
We are about to burn the bridges to this tradition from both ends.
Read it all, because this is what is coming to your town soon with Obamacare. Some of you have already seen it. Mass-market medicine, by the rule-book, "delivered" by anonymous "providers" to the masses. I plan to stick with the old ways for as long as I can.
Amen. As the daughter and employee of an "old-school" surgeon, I cringe when our patients' care gets compromised by an ever-widening, increasingly impersonal, and frankly, dangerous circle of hospitalists. They spend more time watching the damn clock and entering useless data into screen after screen of their venerated EMR systems while patients, aware or not, are getting lost in the black hole of our country's healthcare system. As if it's not scary enough now, I tremble at the thought of our care in "a medical generation or two."
PS: I called an unnamed insurance company today to follow up on one of our surgeon's unpaid claims. After 45 minutes and 3 phone transfers (from Rashid to Amar to Mandeep, I kid you not), they informed me that I submitted the original claim with an unknown practice location. Translation: I included our office suite number in the return address as I had not done previously. How much time, paper, manpower, and patient care (not to mention domestic employment) were compromised by this minute detail?!
T.G.I.F. is all I have to say. Problem is, Monday will come soon and the state of American healthcare will only be worse.
Good practice is not simply correlated with type of system.
Two opposing examples.
I worked for the Indian Health Service as a GP (mostly pediatrics, but delivered babies, skin transplant, rattlesnake bites and such). I truly enjoyed the practice. I could provide the best medical care I was trained to give, I did not worry about malpractice (IHS system); the patients were deeply appreciative; I was on-call every fourth night. Near the end of my service, the Sioux invited me to their sundance ritual (I was the only physician inivited; the others spent their walk-rounds preaching religion to sick patients: not what I was trained to do.)
On the other hand, when I was head of child psychiatry and training at a children's hospital, I was doing walk rounds on the Pediatric ward each morning and evening. One of the residents who had initiated a consultation on a child. When I suggested further evaluation that evening, the resident said she had to leave at 5 p.m. (I knew as did the others that she was going to an evening job moonlighting as a child psychiatrist, which was against rules for trainees.)
I told her that if she left before finishing evaluating the child, she should n't bother coming in the next day. She finished the evaluation.
Understand that when they say 47 million don't have insurance half of those people are illegal aliens. It is their intent to provide free health care to illegals. It is also part of their plan to cut health care for seniors. It will be done by a committee i.e. the death panel, who will decide what treatment is paid for and what is not. The result will be in a few short year you will see the day when grannie or you will be denied life saving care while illegals will be getting all their care free. Welcome to the Democrat dream.
Well, 30 years ago we were beginning to be able to do something in medicine, but if these "inherited values" were so all-fired good, let's see what they looked like in the times they were inherited from.
Doctors couldn't do much for you until beginning about 1950, the tide started to turn. Those old-time doctors could set a bone, give you something for diarrhea or constipation, tell you if your heart was good enough to go in the army, and diagnose what you were about to die from. No wonder that they worked up a comforting presence and aura of caring - they didn't have much else to give.
Even at that, I'm not so sure. The old doctors I recall from my younger days were not such fine fellows - they were arrogant quacks, mostly, fond of telling you how much wiser doctors were in the old days and recounting cherry-picked anecdotes of how the old country doctor had bested the fresh new smartass kid fresh out of residency.
As with education, cooking, character, and just about anything else, we choose our stories to confirm how much better everything was in the good old days. I ain't buying it. There are bad trends in medical delivery now, but there were bad trends then as well.
Assistant VIllage Idiot