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I’m tired of hearing know-nothings talk about medicine. But who is responsible for carrying the discussion?

A Samuel Beckett play is somewhat like a confession without hope of absolution. A sense of sin that lies too deep to be expiated. Past societal guilt (just fill in the blank with your favorite guilt) about present actions continue and such remorse is denied relief. Beckett’s characters reach out to one another for affection, and frustratingly embrace only the perturbed and tormented feelings of themselves.

You would think by now that I have just gotten back from the theater. Wrong! I am just currently watching the Sunday morning “talking heads” which nicely fill out the time slot between 9am and noon as the bagels and coffee are consumed.

A discussion is going on about healthcare which is being conducted by four people who have no idea of what healthcare really is. They somehow believe there is a direct correlation between the amount of money we spend as a nation and how long and how well we live. This flies in the face of the fact that as the country with the largest healthcare budget per person on the planet (2.4 times our nearest competitor), we have just fallen from 37th to 42nd in the world in infant mortality, 21st in male longevity and 19th in female longevity.

While the United States approaches 20% of the gross domestic product being spent on healthcare, the country which is number one in infant mortality will spend about 5.8% of the gross domestic product on healthcare – Singapore. To hear two U.S. Senators, both of whom are lawyers, drone on endlessly about the need “for more or less” government spending enrages me. The pandering to the public is disgusting. To say that the Roman age of “bread and circuses” is back is an understatement. No nation ever sued or spent its way to greatness.

While we are on the subject please tell me why American physicians have abrogated their responsibility to the public. Every time I write a check for AMA dues I wonder why. Why have they abandoned us believing the only real interest of members is their own income and not the better healthcare of the citizens of the United States. This is an organization which has provided essentially no leadership through this morass of healthcare. They were so busy defending income that they forgot that there were larger questions on the table. So now, those least informed, least understanding diminishing return on healthcare money and those least educated in science and its’ limitations are to be viewed as spectacle carrying on such debates. There are precious few people with MD degrees who are waging these fights and it is a comment on both physicians, their organizations and the public in general that we have degenerated into non fact based and uninformed diatribes on how healthcare needs to change. Shame on all of us.

Don’t you ever wonder why people who have done something real in life aren’t running the country? Why isn’t someone who has a concept of end-of-life expenditure dilemmas – or even a knowledge of the meaning of the term sensitivity and specificity – ever found in these debates? The talking heads all think there is a crisis, but none of them are willing to do any primary process thinking to define what we want this life to be. “Dust thou art, to dust returneth” was not written of the soul. Nowhere in The Constitution are we guaranteed a daily bowel movement, let alone everlasting life. I propose a real discussion about both the rights of citizens and their concomitant responsibilities for their own healthcare. I propose a forum on a formula for healthcare surcharge using the formula BMI times packs-of-cigarettes-consumed-that-week and the number-of-times-you’ve-gotten-drunk-and-threatened-to-sue-an-emergency-physician-who-is-only-trying-to-help-you. I am still working through the modifications of dietary intake. But as a fellow sinner, I need to be careful here lest I become a major contributor to the fund. 

Last weekend I did, however, see the ultimate in what can only be considered a death-by-food concoction while attending the classic car auctions in Auburn, Indiana. Right there in the middle of the food midway was a vendor selling the penultimate ER disaster – a donut bacon cheeseburger with eggs and chili optional. Does it get any better than that? Cynicism is not my general cup of decaffeinated latte, but it is a convenient location from which to observe the decline and fall of a once great society.

Why don’t we get back to deciding that the individual is responsible for themselves? When do we as medical community participate in calling a halt to the insanity of ICU beds for demented patients? When are we as physicians going to demand that American expectations are brought in line with American resources? Our problem is we have – no pun intended – lived off the fat of the land for too long. Our problem is there are more people getting rich from America’s illnesses then dying from them. We only steer the great ship of a human’s life within a few degrees. And we constantly pat ourselves on the back for successes that were truly the vicissitudes of nature. News flash, the talking heads just suggested the Obama plan would give young adults complete access to yearly physical exams that would “save more lives.” These people really don’t understand 20-year-old males do they? God help us. I’m going to change the channel now. I can’t take it anymore. Again I ask the question, why are we led by functional idiots who believe that science is magic and that people, if only treated right, will live forever. There is no rational basis for the current suggestions on health plan modifications and it is frightening to think that the black hole of healthcare gets deeper and wider without the care becoming better.

Oh no, it’s worse. I’ve gone from watching Godot to O’Neill’s A Moon for the Misbegotten. The “misbegotten” this time are three lawyers/congressmen (80% of congress are lawyers) are talking about energy issues. Great, just what I need are people who never took physics – and wouldn’t know Maxwell’s equations from their butt – talking about energy creation and distribution. I bet none of them can state Ohm’s law or cares that they don’t understand what they’re talking about. My next channel brings up a special on Al Gore inventing the internet. Now you’re talking.

 

Comments   

# OK, so now what?William Jantsch 2011-10-13 08:52
Greg,
As always, I enjoyed having you share your observations and thoughts. I also happen to share most of your opinions (hence the appropriateness of my praise for your "keen and insightful thinking...")

But where do we go from here? Are we physicians doomed to "observer status" while the ship of US Healthcare sinks before our very eyes?

I have to believe that our healthcare situation is not beyond hope of repair; we just haven't begun to take the proper steps to set it right. Maybe if we found just a few "baby steps", some small, achievable reforms that are heading in the right direction, we could develop some positive momentum.

I know we can not count on the talking heads to create those opportunities. Those of us in active medical practice need to do that for ourselves and for our patients.
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# John Clark 2011-10-13 09:50
I find myself agreeing with much of what you had to say in this essay. Identifying the problem is always step number one, but step two is proposing solutions. When I find myself angered to the point of apoplexy by what the political talking heads have to say about "healthcare", I find no solace when I come across an equally disturbing roundtable discussion by healthcare "experts", all with an MD or DO after their names, but usually followed by a veritable disclaimer like JD or MBA or worst of all MHCA (or an equally nystagmatic affiliation with one prominent university or other). These guys have even more gall than the politicians, as they expectorate statistics that suggest to them that the problems with healthcare in America boil down to "policy." When was the last time ANY of these analysts saw a patient on their own, and had to be a doctor and make a decision?
Anyone with even a modicum of experience working in a contemporary American ER knows the answer to getting "better" healthcare in the U.S. is NOT figuring out ways to deliver MORE healthcare. We tried that before: 25 or 30 years ago we were met with daily headlines about hunger in America with policy makers wringing their hands about solutions. Now those headlines have been replaced by equally alarming statistics and hand wringing about the obesity epidemic! My response, "WTF!! you want to give Americans MORE healthcare but somehow at a lower total cost???" As Lebowski once said, "Has the whole world gone crazy!" We already have a system where anyone, anywhere can go into any ER and have any problem, both real and imagined, evaluated by a professional. If they want, they can go to any number of ERs and have the same problem evaluated, over and over again, without putting up one red cent. Doctors who see them are hamstrung by the specter of the "one in a million possibilities and so called malpractice assertions". They must worry more about "customer satisfaction" surveys than being honest with their patients. The hardest, most energy sapping part of being an ER doc has become resisting the temptation of being honest and saying something like, "well, if you want my opinion, I think you're nuts."
So let's figure out a way, policy-wise, to make the system even MORE accommodating?? ? That's insanity. What Americans need is for someone (who is not running for office or subject to appointment or success based on popularity) to stand up in front of the whole country and say, "Enough already, stop seeking relief from every one of life's simple discomforts. If you stubbed your toe, wait about 15 minutes before you dial 9-1-1 and see if it won't get better on its own.
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