Daily Observer
Now You Are Doctor Provider
but
No Longer in Control of Your Profession
S.Q. Lapius addressed
the graduating class of his medical school.
“It is ordinarily a
privilege for a member of one generation to address representatives of another,
to welcome them across the gap of years as successors in medicine, the noblest
of professions. In the past, alumni
could look forward to the pleasure of accepting new graduates in to the
profession with certain knowledge that the generation gap was relatively
insignificant.
This, alas, is no longer true. The medical tradition, based since the time
of Hippocrates on the sacred trust of the doctor-patient relationship, is no
longer intact, and in fact is so distorted that the new graduate may find
himself in a terra incognita for which he is entirely unprepared by his medical
curriculum.
When I entered medicine
I had no doubt that all the skill I could acquire would be placed at the
service of my patients. In what other
profession does a stranger walk into an office and lay bare his soul and body
with the faith and implicit trust that a M.D. degree evokes?
This act of faith by the patient has been earned by
doctors throughout the long tradition of their art. The professional and ethical standards of the
medical profession have guaranteed to the public the highest standards of
excellence, of proficiency, of compassion.
To whom other than the closest relative would a person entrust himself
on deathbed? Or an operating table? Yet patients continually put this trust in
strangers for no other reason than the fact that the M.D. degree has proved the
worth of this trust. Had medicine
represented anything less than this relationship, I could never have become a
doctor, nor could most members of my generation of doctors.
But things have changed
and I cannot, in good faith promise you a rose garden. The roses are withering on the vine and
aphids are nibbling the leaves.
The profession of
medicine is under attack, based on the premise that the doctor represents no
more than another member of the health team.
There is a movement afoot to destroy the elite position of the doctor
and of his profession indeed to destroy the concept of elitism. The dictionary defines elite as “the best or
most skilled member of a given social group.”
Certainly, according to this definition, medicine is an elite
profession.
But today you are about
to enter a world where you, the doctor, the elite professional, will become
subordinate in your practice to a rabble of administrators who have the
authority to govern your acts as physicians, dictate the method of your
practice, while leaving you, doctor, with the final responsibility.
Who, after all, becomes
an administrator? Anyone who can’t build
a bridge, design a building, paint a picture, compose a sonnet, heal a sick child;
those devoid of any talent or ability in the particular, and no ability in the
abstract, somehow wander into the wasteland of administration, vaulting by
title alone the impediments that you have had to conquer by sweat and will,
concentration and sacrifice, to become your superiors in a field which they
know nothing. These individuals, be they
in charge of Medicare or Medicaid, Blue Shield or Blue Cross, or any duly
constituted authority concerned with health, will direct your lives, determine
your fees, force you to work with the tools they supply, deny you the right to
the best equipment money can buy, and, in general, define the terms under which
you will practice medicine.
You will find yourself
concerned more with the cost of patient care than patient care itself. You will find yourself badgered to discharge
patients from hospitals before you feel they are ready to leave, or else face
the opprobrium of an invisible administration whose concern for cost control
threatens to disrupt the relationship between doctor and patient. The doctor in your brave new world will
simply be another utility, supplying governed output for governed rates. In short, the profession of medicine is
beleaguered.
I don’t plead for the
doctor. Under this new system the doctor
will not be the victim. The victim will
be the patient, because the fundamental doctor patient relationship has been
distorted to such a degree that the patient no longer can know with certainty
who, finally, will be responsible for his welfare. In whose hands does the patient now place his
vital self, his well being? A doctor, a
nurse, a social worker, a computer in some remote and nameless office of a
government designated insurer? Will it
be the hospital administrator, the board of trustees, the charge nurse or the
janitor who will bring the healing arts to patient in his hour of need?
Ironically, although
you are on the verge of receiving your M.D. degree that entitles you to be
called ‘doctor’, health agencies will refer to you as a ‘provider’. In this respect you are lumped with all other
‘providers’ of health care, including the deliveryman who supplies linens to
the hospital.
Try that on your
shingle, John Doe, Provider. Welcome to
the ranks and good luck.”
Afterwards, I said to
Lapius, “Goodness, but you were very uncompromising. Did you mean everything you said?”
“I guess I did,
Harry. The point is that although I can
do the job of any of the providers, none but a doctor can do my job.”
“You are an elitist,” I
said.
Lapius took out a black
cigar and peered momentarily along its sleek length before answering, “I guess
so, Harry. By the sweat of my brow, I’m
an elitist. Any doctor who can do more
for his patients than I can, is more elite than I am.”
He chomped on the
cigar. I struck a match. “Here, let me elite your stogie for you.”