Doctor, Doctor! Where are you?

The Rod of Asclepius, symbol for doctors, came from the Greeks. But the Silk Road exhibit would suggest modern medicine really began with Muslims. In more modern times, the Star of Life is the symbol of health. But does sickness pay more than health?
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Six hundred ninety-nine doctors answered a recent survey of doctors’ attitudes about Obamacare, and medicine in general. Nine in ten of them say that medicine is on the wrong track. Five in six might quit. Liberals, of course, refuse to believe that. (They dare not tell so many doctors not to let the door hit them on the way out!) But even conservatives aren’t paying attention to everything the doctors said in that survey, or why they might have said it.

Doctors talk back

The Doctor-Patient Medical Association is a new idea. Why should doctors and patients fight one another? The DPMA has a new message: doctor and patient have the same interest, deal with the same reality, and sometimes have the same enemies.

From April 18 to May 22, 2012, the DPMA asked doctors across the country about the putative President’s health care reform bill, and about other frustrating things that doctors have to deal with. Two days ago they published their Physician Attitudes Survey. Most of the 699 doctors who answered the survey are in solo, group, or office practice. (Eleven percent are in hospital-based practice. That could include the doctors who run the lab, the emergency room, and the X-ray department, and put you to sleep when other doctors operate on you. But it could also include internists and even surgeons who see all their patients in one hospital and even draw a hospital salary.) More than three out of four were in the middle of their careers. (House officers, the “Young Doctor Kildares” did not answer this survey.)

Their answers should make everyone take notice. Nine in ten said that medicine was on the wrong track, and five in six thought about quitting. Some of them might have to quit: two in three say they are barely breaking even or losing money on their practices.

They don’t want the government to help them. They just want the government to get out. And it’s not that they “don’t care.” Slightly more than half of them would rather treat some patients free of charge and not deal with Medicare or Medicaid to treat the same patient.

I  want to focus on what is best for my patients and not what a government official deems cost effective…I would be willing to do charity care weekly for the poor and underinsured if there was tort reform.

For that matter, they think medicine is off the rails as it is. Medicine, as they must practice it today, harms the doctor-patient relationship. For that they mostly blame the government. But they also blame the big insurers, and the big corporate hospital systems.

The best single thing that can repair most problems, the doctors said, is for the government to get out. But further than that, patients should ditch the insurers and start paying their bills directly. So naturally those doctors want to see the kind of reform that would let a patient do that. One doctor said:

Only the free market will fix this mess. We need to eliminate government and government-protected corporate greed from medical care.

Reporters miss the point

The Star of Life, symbol of medicine, and of doctors.

The Star of Life, featuring the Rod of Asclepius, the true symbol of medicine. Photo: US Department of Transportation

Liberal reporters belittled the survey. That should surprise no one. But The Daily Caller did not do such a good job, either. They picked up on the five in six doctors ready to quit medicine. But they didn’t pick up on the other things the doctors said. They at least let Kathryn Serkes, co-founder of the DPMA, sum up:

Doctors clearly understand what Washington does not — that a piece of paper that says you are “covered” by insurance or “enrolled” in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops.

But they missed this gem:

Are there any long-term Government run programs that aren’t riddled with inefficiency and corruption?

Nor did they quote any of the other opinions that doctors expressed. Yes, doctors blame the government, but not only the government.

When the airlines were taken over by business instead of being run by pilots, the industry went to hell. Same thing has happened to “healthcare”— doctors used to run hospitals and their practices. Now they are “providers.”

An old problem

The problem, and the debate, are decades old. Ayn Rand called the doctor “the forgotten man of socialized medicine.” In Atlas Shrugged, she said this:

In all the discussions that preceded the enslavement of medicine, men discussed everything—except the desires of the doctors. Men considered only the “welfare” of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, but “to serve.” That a man willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards—never occurred to those who proposed to help the sick by making life impossible for the healthy.

Enslavement can take many forms. Sometimes it starts with programs that offer carrots first, and sticks later. Before Medicare or Medicaid, doctors-in-training often worked for “slave” wages. The late William A. Nolen (The Making of a Surgeon), who trained at Bellevue Hospital in the era when Atlas Shrugged came out, earned $780 a year as an intern and about three times as much as a chief resident.

Nobody, at least nobody with a family, could get by on these wages,

Medicare changed everything. House officers today earn not much less than police officers or teachers in a public school. When Medicare started to fund care for the elderly, it funded training of doctors after medical school. The old-school attending doctors often resented the new trainees, who had no concept of what their economics had been like:

In my day, I sold my blood for toothpaste money!

But these new salaries also got doctors used to having the government pick up the tab for everything. Now they’re afraid to lose all the “benefits.” An empty belly can be as strong a chain as iron. (The attendings have their own “hook”: federal and other government grants.)

They also developed no concept of the value of a patient’s means. No one was going to tell them, as a private attending once told Dr. Nolen:

Please don’t order all those expensive blood chemistries on Mr. R___. He can’t afford them and I don’t understand them anyway. In two days he’ll be eating and drinking, and he won’t get into any trouble in so short a time.

Today it’s worse. Doctors order everything because they’re afraid that someone will sue them if they don’t!

Charity patients never have to worry about how much their care will cost. But private patients don’t have that worry, either. They find out later, only if “insurance doesn’t cover it.”

No wonder doctors are ready to quit. Obamacare might push some of them over the edge. But doctors have been ready to quit for years. You have to read all the results of that survey to get that message.

How to solve the problem

Leonard Peikoff, during the “Hillarycare” debate, said that health care is not a right. But Peikoff did not object only to direct government action. He decried all the things that insurers (many of whom follow the government’s lead) do, that distract doctors from caring for their patients. Sometimes that leads to tragedy.

No, health care is not a right. Neither is it a “privilege,” as Rep. John Lewis (D-GA) bitterly declaimed on the House floor yesterday, and declaims on his Web site. Health care is a good, like a car (or repairs on it). If you want something, you work for it or pay for it.

The doctors who answered the DPMA survey understand that. They pointed out that if patients had to pay or budget for medical services, as they do now for car repairs, they might take better care of their bodies, and do many things that would either stop them from getting sick, or catch a sickness early.

More to the point: government often hurts not only the doctor but also the patient. Free minds and free markets will solve the problems that governments, and insurers (to a lesser degree), have caused.

Related:

Ayn Rand world: public hospitals

Editor-in-chief at | + posts

Terry A. Hurlbut has been a student of politics, philosophy, and science for more than 35 years. He is a graduate of Yale College and has served as a physician-level laboratory administrator in a 250-bed community hospital. He also is a serious student of the Bible, is conversant in its two primary original languages, and has followed the creation-science movement closely since 1993.

19 Responses to Doctor, Doctor! Where are you?

  1. JT says:

    Oh dear. A “survey” conducted by a veteran of AAPS, who – let’s face it – consist of bunch of “doctors” that I would not want to treat a pot plant, never mind a human. Not to mention, these “doctors” support the Tea Party and are anti Obamacare (as well as anti-vaccination and immigration), it’s hardly a representative modelling.

    Not only that, but they have one track minds. The question was: “How do current changes in the medical system affect your desire to practice medicine?” and most of them immediately thought “Obamacare!”

    It also shows that they’re more worried about money than treating people.

    Honestly, if these so-called “doctors” want to quit, the US health system would be better off without these hacks and quacks.

    • Terry A. Hurlbut says:

      You just asked for it. Let me quote the last part of Ayn Rand’s remarks about the forgotten man of socialized medicine:

      [You have to wonder] at the smugness at which people assert their right to enslave [doctors], to control [their] work, to force [their] will, to violate [their] conscience, to stifle [their minds]. Yet what is it they expect to depend on, when they lie on an operating table under [a surgeon’s] hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. [Suppose the doctor chooses to withdraw it? Then] let them discover the kind of doctors that their system will now produce. Let them discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn’t.

  2. I don’t think one could honestly name any government programs that have not created any negative unintended consequences. Whenever government barges in to control, the crumbling process is set in motion……..

    Pastor emeritus Nathan M. Bickel

    http://www.thechristianmessage.org
    http://www.moralmatters.org

    • DinsdaleP says:

      “The Doctor-Patient Medical Association is a new idea.”

      From what I can see, the DPMA is just a repackaging of the AAPS, with many of the same key players involved. The only difference is that the marketing pretends to be inclusive of patients’ interests, but a quick scan of the positions being advocated by the DPMA shows that the actual well-being of the patients is not a priority.

      I also read the original survey, which is laughable in how loaded and/or leading the questions are. The telling facts for me are:

      – There are about 691,000 practicing physicians and surgeons in the USA as of 2010, so with 699 individuals responding , 0.1% is not a significant enough sample to mean anything.

      – There was no disclosure of where the polling sample was drawn from, and the demographics provided tell nothing about whether there is an inherent bias to the sampling population itself.

      – The entity behind the survey has a clear agenda rather than polling to find out the opinions of physicians whether they agree with that agenda or not. They could have hired a reputable, professional polling firm to conduct a truly objective survey, and the fact that they didn’t speaks volumes about the meaningfulness of any numbers reported.

      For all we know, they could have used the AAPS mailing list as the basis for drawing their sample – nothing is stated about the sourcing. Considering that many of the questions are politically loaded, it’s VERY telling that the demographics don’t mention what percent of the sample and respondents are Democrats/Republicans/Independents.

      The one clue that is available is in Question 19 of the survey, “Please grade the job medical associations & their leaders have done representing you & your concerns as a physician.

      The AMA gets an “F” in response, but look who gets an “A” among others:

      The AAPS
      The Christian Medical Association
      The Catholic Medical Association

      Seems unlikely that the survey population was as representative of the 691,000 practicing physicians and surgeons as the DPMA wants to pretend.

      Finally, is it just me, or does it seem a bit redundant that the actual, full name of the DPMA is the “Doctor Patient Medical Association Foundation”?

      “Association Foundation”?

      • Terry A. Hurlbut says:

        First of all, the American Association of Physicians and Surgeons still exists, so one organization is not a “repackaging” of the other.

        And second, why don’t you push the lump out of your throat and say what you have against the AAPS or the DPMA? Is it merely that they oppose Obamacare and you favor it? That they oppose socialized medicine and you favor it?

        And about the AMA getting a failing grade: well, you take it from somebody in a direct position to know. The AMA has done a very poor job of representing physicians’ interests ever since they started playing ball with the United States Government, and turned over Index Medicus to the old Department of Health, Education and Welfare. The common joke when I was in medical school was:

        JAMA is fifteen dollars a year. Yes, I know that JAMA is free with your AMA student membership. That’s what I mean when I say that JAMA is fifteen dollars a year.

        The AMA is a bunch of political hacks, all greasing for cushy jobs in the Obamacare bureaucracy. I have no respect for them whatsoever.

        • DinsdaleP says:

          Let me clarify then – the DPMA is a “repackaging” of the AAPS, not a replacement, in the sense that it pretty much takes the AAPS agenda as-is and promotes it under the banner of a group that supposedly represents the interests of patients and physicians, not just physicians.

          Same agenda, different branding – corn flakes in a new box are still corn flakes.

          My issue with the AAPS comes right out of your idol Ayn Rand’s novel The Fountainhead. This isn’t really about advocating issues that matter to physicians as a group – the AAPS is a conservative advocacy group that pushes social policy agendas under the guise of representing a group most people implicitly trust.

          This is right out of the Ellsworth Toohey playbook, as when he formed the Architects’ Guild of America to push his agenda while presenting the appearance of a consensus view among these professionals as far as the public is concerned.

          Are there physician members of the AAPS? Of course, but what they lobby for has more to do with the conservative agenda, but by using the label “American Association of Physicians and Surgeons” instead of the more accurate & honest “Conservative Association of Physicians and Surgeons”, it creates the illusion that the goals of the AAPS represent a consensus view and not simply a conservative one.

          That’s just simple deception, and that’s what I resent.

          • Terry A. Hurlbut says:

            The AAPS promulgates that agenda for the best reason in the world: it works. Socialism does not work. The AAPS never ask for any special government perquisites or positions. They seek only to be left alone, and for all doctors to be left alone.

            So why won’t you (“you” meaning “policymakers for whom you vote”) leave us alone?

          • DinsdaleP says:

            The AAPS promotes what it thinks is the best, which it’s entitled to do, but I suspect it’s as representative of the overall national pool of practicing physicians as your 600-odd people returning a survey is.

            Considering how the DPMA won’t disclose where the survey population list was drawn from, or the social/political demographics of the base, it seems clear that this is information they didn’t want people to evaluate along with the results.

            Oh, and before you say things like…

            “So why won’t you (“you” meaning “policymakers for whom you vote”) leave us alone?”

            …you need to stop cheering on the same policymakers for passing laws that:

            – Apply regulations to clinics providing safe & legal abortions that don’t apply to other comparable practices.

            -Laws requiring unnecessary extra visits and waiting periods for legal procedures requested by patients.

            -Laws requiring doctors to perform actions not medically necessary to the legal services requested by the patient.

            -Laws requiring rape victims to be forcibly, trans-vaginally probed by doctors to obtain ultrasounds that are not required for the legal service requested by the patient.

            In short, don’t be a hypocrite an insist on having it both ways where the doctor-patient relationship is concerned.

          • Terry A. Hurlbut says:

            So you play the abortion card again.

            Abortion = manslaughter.

          • MatthewJ says:

            “Abortion = manslaughter.”

            Why not murder?

          • Terry A. Hurlbut says:

            “Murder” has a special meaning in the law. Even murder in the second degree implies a deliberate intention, formed either at the instant or earlier. Murder also implies knowing, deep in the heart, that someone is going to die, and that it is wrong to bring about that death. Manslaughter implies carelessness, either in not knowing one’s own strength or in not having thought the matter through. That is as much as I am prepared to allege at present. I leave the parsing of the law to those better trained in it than I.

  3. DinsdaleP says:

    “Abortion = manslaughter” may be a deeply-held belief on the part of millions, but in the eyes of millions of others as well as the laws of our nation, it is a legal right for a woman to make that choice and obtain one without it being a crime.

    Unless the laws change, it’s a legal medical procedure, and in the absolutist worldview of you and the AAPS, that means the government has no right to use regulations to interfere with the doctor-patient relationship that ensues.

    • Terry A. Hurlbut says:

      Then it’s my job, as a journalist, to stand up for a group of defenseless unborn children whom you, I presume, wish to destroy. I won’t even ask you why you wish that. I don’t give an unripe fig. Because you simply cannlt—cannot—justify such action under any theory of law.

      • MatthewJ says:

        I’m still curious as to what you feel distinguishes it from murder. If, as you say, it cannot be justified under any theory of law, then why not murder?

        • Terry A. Hurlbut says:

          Manslaughter is not justifiable, either. Didn’t you know?

          “Justifiable homicide” would be a death for which no prosecution is appropriate.

      • DinsdaleP says:

        I think there needs to be some clarity on this, Terry.

        -I don’t favor abortion.

        -I think it’s morally wrong to use abortion as a form of post-conception birth control for people too careless to take sensible steps to avoid pregnancy in the first place.

        -I’m a father of three and a stepfather to three more, and I value life dearly. My first wife and I also went through a miscarriage together, and I felt the loss as acutely as if one of my older children had died.

        -I, and millions like me, greatly value life despite our support for a woman’s right to choose what happens within her own body.

        I don’t walk in your shoes, but you don’t walk in mine either, and it’s reprehensible that you sit smugly at a keyboard and presume that I or anyone else who disagrees with you on this has a “wish to destroy” unborn children.

        You’re probably not able to get your head around this, but it’s my respect for life that makes me a supporter for a woman’s right to make this choice without the government telling her what to do.

        I hold all life as equal in worth, and for me that means that a woman does not lose her rights as a human being when she becomes pregnant, whether by choice or by rape. You hold a fertilized egg as a human being innocent and deserving of protection, but why does that make the person carrying that egg suddenly nothing more in your eyes but an incubator obliged to serve in that role for the next nine months – or else.

        I hate it when a woman or young girl is raped, and people say “make lemons from lemonade, carry the pregnancy to term, and give it up for adoption if you don’t want it”. I hope no one ever goes through that experience but we all know that women do every day, and none of us truly know what damage the person has already suffered, mentally and emotionally, up to that point. She should be free to seek family and spiritual guidance to help her, but I feel it’s morally wrong to have any stranger, let alone the government, order her to give up control of her body for the next nine months. It’s her body, and if all life matters then her life matters too, not just the fertilized egg’s, and it deserves respect.

        I also believe that a fertilized egg is not a person, and does not deserve the protecttion of a legal “person” in the eyes of the law. It has the potential to be a person, but it’s not there at that time.

        I also believe that a fetus that can survive outside the womb can be regarded as “human”, and that terminating a pregnancy at that point would be a form of homicide unless the mother’s life was at risk. In the former case the baby can be saved without harm to the woman. The latter case is a tragedy of fate, much like two conjoined twins who can’t both survive, and no one considers it murder that one is chosen rather than both dying.

        So yes, Terry, I live with a contradiction that a fertilized egg is not a human with human rights, but that a stable fetus in the 9th month is, so where is the clear rule that divides the human from the non-human?

        I don’t know, and I admit that with no hesitation. I strongly doubt there will ever be such a rule that works in all cases.

        This is the point you can probably pounce, Terry. Anyone who makes up a rule is just playing God, whether it’s saying “first trimester”, “before pain can be felt”, “when external support can preserve life”, and so on – they’re all arbitrary in the end, and in any case, each pregnancy is unique.

        I’m not God. None of us are. None of us should ever pretend to be.

        That’s why I don’t support destroying life, but support a woman’s right to make that choice for herself. It’s not my business to know the circumstances, to probe into her life until I’m satisfied regarding the situation and her intentions. She has a right to privacy regarding her life and her own body, and that was the essence of Roe v. Wade.

        In the end, if you truly believe in your Christian faith, Terry, then there will be a judgment for the choice, and it’s not our place to judge but Another’s. All we can offer is encouragement and support for choosing to carry a pregnancy to term, but we can’t claim to respect life if we don’t respect the woman’s life as well, and let her make her choice.

        I know three women who have had abortions, and each of them believed that they made the right decision at the time. Two of the three had children later, and each child reminds them every day of the potential that they ended by their own choice. One of them was disgusted at how casuallly some of the other women in the clinic seemed to regard the decision – for her it was gut-wrenching. The third never had a child after, and often thinks about the life as a mother that could have been, and will never be at this point in life. I don’t judge them, Terry – they are three wonderful people who made a difficult choice earlier in their lives, and whether it was ultimately the right thing or not is not ours to say. Having free will means having the freedome to make difficult, sometimes controversial choices, accepting the consequences, and growing from them. The one common element to each of their stories is that the decision involved what happened to them and their bodies for the next nine months, and if we believe in liberty and free will, then none of us had the right to take the choice from them.

        I’ve contemplated the pro-life position, Terry, and there’s a consistency to “human life begins at conception” that I respect. But if we really go down that road as a society and embody that principle as law, then every lost pregnancy is a
        death to be investigated, and the formally-pregnant woman the prime suspect until natural circumstances are established as the cause. Any pregnant woman caught smoking, drinking, or not doing what’s in the best interest of the fetus is committing child abuse at the least, or attempted murder at the worst. Every couple conducting in vitro treatments is guilty of murder if they cause eggs to be fertilized, and then fail to implant every one and bring them to term.

        We also can’t be hypocrites. If we define human life as beginning at conception, then every woman who’s had an abortion withn the statute of limitations for first degree murder has to be prosecuted. Anything less is treating the aborted as “not quite human”, but removing that distinction is the whole point of personhood laws.

        So go ahead and think of me as a life-destroyer – sticks and stones as far as I’m concerned. There are just many of us who value the lives and rights of the women who have been born as the lives that might be born if carried to term, and respecting those lives means respecting their right to choose what happens within their bodies for their entire lives.

        I don’t have a simple rule or answer for when abortion should be acceptable and when it should be banned. “Only prior to when a fetus can be safely removed and brought to term without harm to the mother” would be my intent, but that’s a grey area. Society has to decide what’s acceptable, and if there’s to be a judgment in the end, then I’ll at least be able to step before the Judge and honestly say I made no pretense to act in His place.

        • Terry A. Hurlbut says:

          No, sir(rah), I cannot wrap my mind around your dodge. That’s right, I said dodge.

          I cannot wrap my mind around the concept of anyone, believing abortion to be homicidal, nevertheless condoning it as a matter of law.

          I cannot wrap my mind around the concept of anyone, purporting to feel as you do, allowing that kind of atrocity for one millisecond.

          But I guess you don’t care about consistency, do you?

          And you dare accuse me of inconsistency?

          GOD DAMN YOU!

          You will apologize to me. FORTH. WITH.

          Or I will never let you publish a comment on my site ever again.

          YOU GOT THAT?

          • DinsdaleP says:

            Guess you read what you wanted to out of that post instead of what I was actually stating, because I never said abortion was homicide.

            “GOD DAMN YOU!”??? Wow. Okay.

            You know, I may disagree with you on many topics here, even vehemently, but I’ve never cursed at you, mocked you, or attacked you on a personal level. I treat forums like this as a civil setting, and have treated you, RoseAnn, and the others here with respect even if I had little respect for some of the positions you advocate.

            You can attack my ideas all you want, but I won’t apologize for expressing them in a civil manner. So if this is the last thing I get to post here, that’s your prerogative since it’s your site.

            Thanks then, Terry, for allowing me to comment here up until now. I’ve respected you for keeping these forums open to a fairly wide range of opinions, and (for the most part) engaging in an exchange of views and not just a broadcast. The views you and your fellow CNaV editors hold deserve to be heard as much as anyone else’s, so best of luck with this site.

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