9 February 2021
I once knew an ob-gyn who posted two framed documents in his waiting room. In those days, the mid-1990s, the room truly was a waiting room, and the office was truly his, not a small, cramped satellite of a managed care monstrosity. Those two documents, hung side-by-side on a wall, were:
Patient’s Bill of Rights
and
Patient’s Bill of Responsibilities.
I smiled at this kindly, crafty, crusty and extremely competent doctor-surgeon: “Clever. Does anyone read them?”
“You have. That’s enough for me.”
By the year 2000, this physician, who had already given up delivering babies, in 1989, due to the skyrocketing costs of malpractice insurance, was herded into the Managed Care Building. “They want me in with all the others,” he growled to me.
I’d already consented to allow a Physician Assistant to conduct the annual exam, instead of this doctor who had begun to carefully and resentfully count the costs of keeping up with the lawyers and managed-care-bean-counters. He’d written a lovely Dear-John to me, one of his longer-term patients. As he contemplated which steps to take toward retirement, he explained that unless I was a Woman With A Problem, he would not be able to attend me. He referred me to his practitioner-assistant who was highly skilled; and who followed his instructions to the letter, which is part of being highly skilled as a medical underling.
I spoke in person with this doctor, wishing to depart his office on amical terms. “Please do not take this personally, sir. But I am not going to develop a health problem to become a Woman with a Problem, just to continue to be your patient.”
He laughed, and I laughed, and the farewell was fairly complete. This former Chief of Staff at a major hospital in Sacramento would thereafter be pushed out of his group practice by cost-cutting measures that he, as a Scots, could not abide. He taught his craft at a local university, and he undoubtedly growled at the bad-mannered students and the bird-brained bureaucrats there.
This keenly intelligent physician-surgeon was among many of his colleagues who were in high dudgeon, all the time, over what was happening within their beloved profession during the 1990s and 2000s. Then, in 2009, the AMA sold out their member doctors to Obamacare. The level of frustration, disgust, anger and anathema from many physicians toward the Managed Care Fonctionnaires soared to new heights. Those doctors had to work alongside their nirvana-happy socialist-MD brothers and sisters. The civil war among physicians, that fratricidal battle between certain types of doctors, deepened to a nuclear level.
The crazy quilt of bureaucratic layers of non-function hand-cuffed every physician trying to be a doctor, at least a good one. In defense of quilting, I must say that at least the Crazy Quilt is pretty to look at; the Obamacare debacle was a grotesquely botched abortion from the start.
The Good Doctor was ordered by the Health-Care Administrator to give the Patient a .2 allowance of exam time; and to rattle off a list of overtly and obscenely personal questions to the Patient to answer, as a way of harvesting superfluous data for the ever-increasing Staff to then feed into the computer analysis animal, to make the Software Experts rich. That intimate info had nothing to do with any illness, disease or even symptoms of a malady. For all the Doctor and the Patient knew, those bits of Secret Data were sold off to the google ghouls!
Those latest intrusions upon Doctor-World resulted in many bizarre and unusual scenarios.
From 2010 onward, the experienced, expert doctors retired early; others took to drinking and self-prescribing pills. The more fractious and rebellious among them slow-walked every patient-visit, extending the .2 allotment time to 45 minutes, sometimes an hour! The chats between Angry Doc and Patient-Doc were inspirational and thought-provoking. A Doc-to-Doc always is!
The early post-Cold War years in America had finally borne fruit by 2008 for the politicians who had been eyeing the Health Care sector to feast upon. It had been practically guaranteed that the parasitic politicians of this nation would own the issue of “Medical Malpractice Reform” and “Portability of Insurance” and “Catastrophic Health Care Coverage” — for decades. Those dirty demagogues never lifted a fat finger to solve the problems created by the Lawyer Class, the villains who were also in on the Medical Fix that eventually morphed into a ramming-speed attempted government takeover of medicine.
It’s a rare and unique universe that true doctors inhabit. That universe, of true doctors, has shrunk — not because of digital equipment, or data analysis, or even the managed care monstrosity. The feckless fonctionnaires clogging up the system will eventually be scraped off of the arteries of medicine, once capitalism and the free market have been freed to breathe within an industry that equals approximately 1/6 of the GDP of America.
The shrinking of the universe of medicine has much more to do with the types of people who have gone to medical school during the past two decades to become trained as doctors. Rather than being driven by the almost-irrational drive to cure disease, too many freshly-hatched medical students want to be taken care of by the Managed Care Monstrosity.
The bulk of the current crop of doctors seeks security from their profession. It has come as a rude, a very rude awakening, the reality that the world of medicine is a wild ride through the unknown. Levels of confidence crumble in the face of unforeseen forces such as evil, something that cannot be quantified or even qualified. It must be survived.
The rugged individualist is a personality-type that used to comprise the bulk of the medical profession — before the advent of the genome map that was supposed to solve every ill, known and unknown to humanity. These young, and I do mean young, physicians cannot emotionally handle the humanity thrown at them, constantly, without respite, and, most recently, during the latest flu epidemic.
The COVID-19 pandemic began the process of separating the boys from the men, and the girls from the women, where being a True Doctor is concerned. The Nanny State in America began to crack under its own sickening weight of fear-driven “science”, and through the widespread, though unintentional, revelation of political medicine in America. During this past year, I very sadly observed trusted physicians who had become phobic about an infectious disease that took on the political potency of medieval hysteria. Staying in the house was the overall consensus among California Nanny State docs.
I exclaimed: I want to be riding Wildfire, not peddling a tricycle with training wheels! Another essay was born - Wildfire.
This past autumn, a time of year that traditionally marks the start of Open Season on Patients by the Insurance Companies, I saw online a hilarious post by Dr. Rand Paul, who is also a U.S. Senator from Kentucky: “Paging Dr. Fauci . . .”
I still laugh at it, even as I type these words. For you see, the world of the medical researcher and the world of the true doctor, particularly of a surgeon, are worlds apart. Just think of the scene in Toy Story, where Buzz Lightyear observes Sid, operating on a doll, and he somberly intones:
“I don’t believe that man has ever been to medical school.”
Oh, Tony, he’s been to medical school. But I don’t think he’s spent a lot of time working in a hospital.
Therein resides the huge divide between the Researcher and the Clinician; the Pinhead Health Care Administrator, who bombed out as a physician, and the Doctor-Surgeon, who soars in silence. There are also the doctors who no longer want to be doctors, but who still want to cash in on the MD degree: the egomaniacs who show up on tv, and write books, and consult, and advise, and become Dr. Snake-Oil of the Soche-media Stars. Hummmm-baby!
The art of healing, the craft of surgery, the gift of intuition that grant to a doctor the insight that merges with his years of training: those elements of medicine have been all but wiped out by the reduction of a physician to a lab technician within the Managed Care Monstrosity. Dammit Jim, I’m a scanner, not a doctor!
This appalling development was underway during the 1990s when I had to say farewell to many doctor-surgeons who knew their profession like the backs and the fronts of their hands. They looked out upon a medical landscape that no longer revered hands, but put far more value in statistics and cost-benefit ratios and the probabilities game, patient-questionnaire software/algorithms and the Bell curve. Those factors have their place in medicine, but they are not medicine.
I had been researching the good old days of tonics in America during the 1880s because my character Lily in THE SILENT HEART becomes addicted to Dr. Good. This morning, I received an email that pretty much puts my historical documentation in perspective.
The potion portion of Pills, Promises and Potions for GPs has been under-represented for far too long! It’s time to bring it back!
Feeling lethargic? Try an ounce or two of this old-fashioned tonic every day: you may be amazed at the results. An invigorating blend of 12 herbs, aged apple cider vinegar and juice concentrates, it's a family recipe that devotees claim helps treat arthritis, high blood pressure, cholesterol and acid reflux. Many others trust it as a daily supplement that boosts the immune system and general good health.The reviews are glowing. Here’s one of the more avid acclaims:
“This stuff is great! Takes away pain of arthritis in hands and knees. Plus never take antacids again!”
I can tell you from personal experience and private discussions with General Practitioners that this sort of thing drives them up a wall. The mention alone of “WebMD” can really ratchet up the blood pressure of the Doctor!
You’re the Doctor is the last step here in the phase of returning care of one’s health to the self. It is not always a wise choice, and it gravely troubles the more sincere of heart among the current cadre of medical students with a license to practice, with a stethoscope, and a job at a health-care-system that overloads his case-load by about 100 patients.
Decades ago, I never trusted a doctor under the age of forty. Nowadays, the competent physician is burned out by forty. A stab cannot even be made to erase the crushing debt created by getting that degree from the ginormous-priced med-school. The med-school itself has become a diseased paper mill, overrun by politics. The politicization of medicine, like the politicization of life, is the sickness that we now all share here in the U.S.A. I say let the body politic heal itself.