12. PATIENTS WOULD BE FURTHER EXASPERATED IF THEY KNEW
THAT WHEN THEY COME TO SEE YOU THERE ARE OTHER PEOPLE
THERE: THE THIRD PARTY REGULATORS, THE OUTSIDERS WHO
EARN THEIR KEEP BY HARASSING DOCTORS. EACH OF YOU
COULD COME UP WITH MANY EXAMPLES OF THIS: HAVING YOUR
JUDGMENTS SECOND-GUESSED LONG-DISTANCE TO SHAVE A FEW
BUCKS OFF THE COST OF A HOSPITALIZATION:

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A. NEUROSURGEONB TRYING TO EXPLAIN TO THE CLERK ON THE
OTHER END OF THE TELEPHONE WIRE WHY THE 10 HOUR BRAIN
SURGERY SHOULD NOT BE SCHEDULED IN THE AFTERN OON,
JUST SO THE PATIENT DOESN'T STAY IN THE HOSPITAL THE
NIGHT BEFORE THE PROCEDURE.

MOST OF YOU ARE TRAINED TO ADVOCATE YOUR PATIENTS'

INTERESTS, AND YOU ARE BETTER AT CLINICAL DECISIONS THAN

ECONOMIC DECISIONS.

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ALL TOO OFTEN THESE INTERFERING REGULATORS FORCE
DOCTORS TO FIGHT FOR WHAT IS BEST FOR THEIR PATIENTS, TO

SPEND TIME ON THE PHONE OR WRITING LETTERS, TIME THAT
WOULD BE BETTER SPENT WITH THEIR PATIENTS.

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I THINK THIS IS ONE PLACE WHERE THE TIDE OF OPINION MAY
BE TURNING IN THE PHYSICIAN'S FAVOR, AS A NUMBER OF
RECENT NEWS PROGRAMS HAVE HIGHLIGHTED THE ABUSES OF

THE REGULATORS,

COST CONTROL SHOULD NOT MEAN REMOTE CONTROL
MEDICINE.

WE DON'T WANT TO SEE MEDICINE TURNED INTO A PUBLIC
UTILITY, OVER-REGULATED AND UNDER-RESPONSIVE TO THE
NEEDS OF INDIVIDUAL PATIENTS.

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BUT, TO MAKE SURE WE ALL GET MORE FOR OUR HEALTHCARE
DOLLAR, FOR OUR INSURANCE COVERAGE, WE NEED DO NEED
MORE OPEN COMMUNICATION ABOUT THE QUALITY AND
EFFICIENCY OF HEALTHCARE.

13. WHAT SOME PEOPLE SAY IS ANOTHER SOURCE OF
EXASPERATION IS THAT THEY CALL THE CONSPIRACY OF
SILENCE.

THEY NEED TO KNOW WERE PEOPLE CAN GET HIGH-QUALITY
AND EFFICIENT CARE.

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THEN THE PATIENTS WILL DESERT THE POOR QUALITY,
INEFFICIENT SYSTEMS THAT WILL HAVE TO IMPROVE OR PERISH.

THE PUBLIC --AS WELL AS OUR PROFESSION-- IS ALSO
EXASPERATED ABOUT GLARING REGIONAL DIFFERENCES.

WHY SHOULD HOSPITAL USE IN THE MIDWEST BE 60% HIGHER
THAN IN THE WEST? WHY, IN A GIVEN YEAR, SHOULD 10% OF
DELIVERIES IN DETROIT BE BY CAESAREAN, BUT IN WASHINGTON

DC CAESAREANS FORM 24%?

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WHY SHOULD SOME REGIONS ORDER CAT SCANS 7 TIMES MORE
FREQUENTLY THAN THE NATIONAL RATE?

WHY DO KNEE REPLACEMENTS VARY 6-FOLD FROM REGION TO
REGION?

THE EXPLANATION OR CORRECTION OF THOSE DISCREPANCIES

SHOULD COME FROM YOU, AND NOT FROM A SOCIAL PLANNER.

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QUALITY, AND EFFICIENCY ARE DIFFICULT TO MEASURE.
BUT THEY ARE MORE IMPORTANT THAN MERE QUANTITY.

WE ARE DEVELOPING TOOLS TO MEASURE MEDICAL NECESSITY,
APPROPRIATENESS, EFFECTIVENESS AND OF COURSE OUTCOMES.

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OUTCOMES WILL BE MORE AND MORE PART OF OUR
RELATIONSHIP WITH PATIENTS.

BATTING AVERAGES OF PHYSICIANS AND HOSPITALS FOR
VARIOUS DIAGNOSES WILL BE COMMON KNOWLEDGE.

BE SURE THEY ARE PROPERLY CALCULATED AND CONVEYED.
DON'T ALLOW THIS TO BE ANOTHER REASON FOR PATIENT
EXASPERATION.

MANAGE THE SYSTEM; DON'T FIGHT IT.

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Tire
MALPRACTICE SUITS CORRUPT, BASIC EMOTIONAL CLIMATE OF

MEDICINE, MAKING THE DOCTOR AFRAID OF THE PERSON SHE

OR HE WANTS TO HELP.

MALPRACTICE DOES EXIST, AND WHERE THERE IS MALPRACTICE
--BAD, OR NEGLIGENT PRACTICE-- RESTITUTION AND
COMPENSATION ARE IN ORDER.

MEDICINE MUST RID ITSELF OF THE BAD APPLES THAT BRING
JUSTIFIED CRITICISM TO THE PROFESSION.

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YET MANY MALPRACTICE SUITS ARE BROUGHT BECAUSE A
TRAGEDY HAS OCCURRED, IN SPITE OF THE DOCTOR'S BEST

EFFORTS.

OUR CURRENT SYSTEM DOES NOT SERVE THE PATIENT WELL.
EVERY INAPPROPRIATE MALPRACTICE SUIT DRIVES UP THE COST
OF MEDICINE FOR ALL PATIENTS AND DOCTORS ALIKE, WHILE
NEGLIGENT DOCTORS CONTINUE TO PRACTICE AND SOME VERY

GOOD DOCTORS LEAVE.

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MALPRACTICE REFORM IS DIFFICULT TO GET BECAUSE
CONGRESS AND STATE LEGISLATURES INCLUDE SO MANY
LAWYERS, AND THEY AREN'T LIKELY TO ACT AGAINST THEIR

OWN.

BUT WE --NOT JUST SURGEONS, BUT ALSO CITIZENS CONCERNED
ABOUT HEALTHCARE COSTS-- WE MUST DEMAND REFORM.

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WE MUST ELIMINATE AWARDS FOR ALLEGED PAIN AND
SUFFERING, AND WE MUST DO AWAY WITH CONTINGENCY FEES
WHICH CLOG THE COURTS, BLACKMAIL PHYSICIAN S, AND
PROMPT INSURANCE COMPANIES TO SPEND OUR MONEY OUT OF

COURT JUST TO GET IT OVER.

 

ALTHOUGH WE MUST HOLD OUR PHYSICIANS TO THE HIGHEST

STANDARDS,
WE MUST REALIZE THAT HEALING AND RECOVERY ARE NOT

PERFECT.

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THE HEALTH CARE SYSTEM IN AMERICA TODAY IS A TERRIBLE
MORAL BURDEN FOR SOCIETY TO BEAR, IN THAT THE SYSTEM

DOES NOT RESPOND AT ALL TO SOME 12 TO AS HIGH AS 15

 

PERCENT OF OUR POPULATION.

AND IT IS A TERRIBLE ECONOMIC BURDEN FOR SOCIETY TO
BEAR, IN THAT THE SYSTEM SATISFIES ITS OWN UNCONTROLLED
NEEDS AT THE EXPENSE OF EVERY OTHER SECTOR OF AMERICAN

SOCIETY.

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WE NEED TO CHANGE THAT SYSTEM.
NOT JUST A LITTLE CHANGE HERE AND A LITTLE CHANGE THERE.

WE NEED TO BRING ABOUT A PROFOUND CHANGE, ACROSS-THE-
BOARD, IN THE WAY WE MAKE MEDICAL AND HEALTH CARE

AVAILABLE TO ALL OUR CITIZENS.

BUT CAN WE DO IT?

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WE NEED TO TAKE SOME IMAGINATIVE STEPS.

FOR EXAMPLE, WE NEED TO SOLVE THE PROBLEM CAUSED BY
THE ENORMOUS EDUCATION DEBT THAT MOST YOUNG DOCTORS
HAVE TO SHOULDER AS SOON AS THEY BEGIN PRACTICING
MEDICINE. |

MOST MEDICAL STUDENTS GRADUATE FROM MEDICAL SCHOOL
WITH A DEBT THAT SHAPES THEIR PRACTICE OF MEDICINE FOR

THE NEXT 20 YEARS.

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BUT I DO HAVE A SIMPLE SUGGESTION ABOUT THE PROBLEM OF

MEDICAL SCHOOL DEBT.

WHEN A MEDICAL STUDENT GRADUATES, AN ACCOUNT COULD BE
ESTABLISHED BY THE FEDERAL GOVERNMENT, AND EVERY TIME
THE DOCTOR SEES AN UNINSURED PATIENT WITHOUT CHARGE,
THAT DEBT IS LOWERED BY THE AMOUNT EQUIVALENT TO A FAIR

COMPENSATION FOR THAT SERVICE.

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THIS SOLUTION HAS SEVERAL ADVANTAGES:
IT'S GRADUAL;

IT DOESN'T REQUIRE A BIG OUTLAY BEFOREHAND;
IT OFFERS CARE TO THE UNINSURED WHO NEED IT;
IT ENCOURAGES PHYSICIANS TO OFFER CARE WITHOUT FEE; —
AND IT LOWERS THE DOCTOR'S DEBT.

IT SEEMS TO ME THAT EVERYBODY GAINS.

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WE ALSO NEED TO DO SOMETHING ABOUT THE INFLATIONARY
ASPECT OF RECRUITMENT MONEY, WHEN HOSPITAL "X" WANTS
THE SAME KIND OF SURGEON AS THE HOSPITAL ACROSS TOWN,
AND THEN LURES SOMEONE FROM ACROSS THE COUNTRY WITH

AN ASTRONOMICAL PACKAGE, FORCING COSTS UP ALL AROUND.

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_ J REALIZE THAT THIS IS A COMPLICATED PROBLEM, INVOLVING
REGULATIONS, JOINT COMMITTEES OF ACCREDITATION OF
HOSPITALS, ETC., BUT COMPLEXITY SHOULD NOT KEEP US FROM

GETTING A HANDLE ON A SOLUTION.

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WE NEED TO DO SOMETHING, TO DO MANY THINGS,

BECAUSE WE ARE AT A CROSSROADS.

WE CANNOT AFFORD TO DO NOTHING, TO CONTINUE BUSINESS
AS USUAL.

THE PRESSURE FOR RADICAL CHANGE IS COMING FROM ALL
DIRECTIONS:

FROM MEMBERS OF CONGRESS, FROM BUSINESS, FROM LABOR,
AND FROM THE GENERAL PUBLIC.

INCREASINGLY WE HEAR THE DEMAND FOR RESTRUCTURING THE
FINANCING AND DELIVERY OF HEALTHCARE IN THE UNITED

STATES.

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EVEN SOME BUSINESS LEADERS WHO NORMALLY CRINGE AT THE
THOUGHT OF GOVERNMENT INTERVENTION OR REGULATION |
FIND THEMSELVES CALLING FOR A SYSTEM OF NATIONAL

HEALTH CARE AS A SOLUTION TO RISING INSURANCE COSTS.

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EXASPERATION WITH OUR SYSTEM LEADS SOME PEOPLE TO SEE

GREENER GRASS ON THE OTHER SIDE OF THE FENCE.

THE GROWING INFATUATION WITH FOREIGN NATIONAL HEALTH

SERVICES IS BASED MORE UPON DISSATISFACTION WITH OUR

SYSTEM THAN UPON UNDERSTANDING OF ANOTHER ONE.

 

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MOST AMERICANS DO NOT REALIZE THAT ANY NATIONAL

HEALTH SERVICE, IS BASED UPON PLANNED SCARCITY.

EXPERIENCE THE WORLD OVER HAS SHOWN THAT WHEN
GOVERNMENT ECONOMIC CONTROLS ARE APPLIED TO HEALTH,
THEY PROVE --IN TIME-- TO BE DETRIMENTAL.

EVENTUALLY THERE IS AN EROSION OF QUALITY, PRODUCTIVITY,

INNOVATION, AND CREATIVITY.

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THIS IS ESPECIALLY TRUE OF RESEARCH.

AMERICANS DESIRE, NOT ONLY AFFORDABLE HEALTH CARE, BUT
ALSO MEDICAL ADVANCES.

BUT MEDICAL RESEARCH IS NOT CHEAP, AND SOMEONE MUST
PAY FOR IT. AMERICANS ARE NOT LIKELY TO TOLERATE
HEALTHCARE SAVINGS IF IT MEANS SKIMPING ON AIDS OR

ALZHEIMER'S RESEARCH.

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