Doctor’s Watch Dog
Daily Observer
It
took some doing, and S.Q. Lapius had to introduce
himself as a former classmate of Charles C. Edwards, assistant secretary for
health of the Department of Health, Education and Welfare, but finally the call
was put through, Lapius motioned to me to pick up the
extension.
“Hello,
Charlie. S.Q. Lapius here.”
“Who?”
“You
may not remember me--.”
“Of
course I do, S.Q. It’s just that I get
so many calls. What can I do for you?”
“I’m
just curious why you are pushing so hard for these Professional Standard Review
Organizations, Charlie. After all, you
are really putting a watchdog on the doctors.
I am not sure they deserve that.
But in addition, it may hamper their care of patients. It’s hard to make independent decisions if
you have some government agency looking over your shoulder all the time.”
“That’s
the wrong way to look at it, S.Q.
Actually, I believe that the PSRO’s can
provide the medical profession with a vehicle for change whereby the best and
most effective of care becomes the standard care. We can establish norms that all physicians
can adhere to. For instance, if a
patient with a heart attack could do just as well with two weeks of
hospitalization, instead of three, then the PSRO should be able to shift the
pattern of care. No one will be looking
over your shoulder.”
“You
will be looking over my shoulder. Why
should a doctor be concerned about what your governmental organization decides
should be the national norm. Every case
must be decided on its merits.”
“But
you know as well as I that three weeks of care for a heart attack is too long.”
“No,
Charlie. I don’t know that. It depends on the case. Sometimes five weeks is too short.”
“But
look at all the hospital beds we would free for other cases, Lapius.”
“If
you are short of hospital beds, Charlie, build more. The practice of medicine has a right to change
slowly. Doctors have to adjust to new
norms at measured pace, not be pushed into new value judgments by a government
agency.”
“You
know, Dr. Lapius,” Edwards was becoming acerbic, “We
must consider society as a whole, not just the patient.”
“No so, Charlie. We
must consider the patient only. He
doesn’t come to us to have us consider him in light of other social
pressures. He wants to survive that
heart attack, and he wants to be in the safest environment possible until he
recovers. Sure we may be extravagant
with time and hospital beds, but that is what the sick person expects and
needs.”
“But
we can’t take care of all our citizens on that extravagant a basis,
doctor. It is not reasonable to expect
that.”
“Why not? We took
care of
“That’s
a political question. We can’t get
involved in that. Incidentally, not to
change the subject, but we are coming out with a new national health insurance
plan, which will afford every American the opportunity to obtain health
insurance, and we are offering a broader benefit package than we had previously
considered.”
“I
see,” commented Lapius, “And you won’t build more
hospitals, but will insure beds for this increased population of patients by
mandating shorter hospital stays, bringing pressure on the doctors to send
their patients home earlier. You know,
Edwards, not every patient who leaves a hospital goes to a posh home, with
proper heating and facilities, or a loving family waiting to render proper
nursing care, or the wealth to buy it.
Some go home to cold water flats, poorly heated, no insulation, no family. Are these
patients going to be discharged early from hospitals?”
“But
Lapius, the nation has to be careful. As we extend health care to everybody, the
bill becomes stupendous. We will have to
raise new revenues. We will have to
manage the system with great restraint.
Otherwise we would have intolerable cost escalation. It is the responsibility of the doctor to
monitor costs.”
“The
hell it is. It is the responsibility of
the doctor to take care of his patient.
That is all.”
“That
is where we disagree, Lapius. The fact is that we can’t construct a system
that is inherently perfect, not so long as patient care is a matter of
judgment. Incidentally, Lapius, I don’t remember you exactly. Were we in the same class?”
“No.”
“But
I thought you told my secretary we were classmates.”
“Well,
thanks for your time, Dr. Edwards. It
was nice talking to you.”
Lapius hung up.
“There you have it, Harry. You
heard him. He is going to take the
judgment out of medicine. Next they will
remove the compassion, and all the elements that make it a humane profession.”
“But
you admit there is a problem. To extend
medical benefits we will have to expect to pay a big bill.”
“Well,
that’s preferable to lowering the quality of care. Medicine won’t be improved by the imposition
of a medical Czar who will tell each of us what to do and when.”
“You
never were in the same class as Edwards, were you Simon?”
“I
would put it another way, Harry. He never was in the same class with me.”
(The
source for this article was written by Dr. Edwards for Medical Tribune,