Patient, Heal Thyself?

Mack Hall, HSG

Mhall46184@aol.com

Patient, Heal Thyself?

Dr. Candice Chen, assistant research professor at the George Washington University School of Public Health and Health Services (how does she fit all that on her business card?) has made a study concluding that there aren’t enough physicians in primary care, especially in rural areas.

Who would have known?

Maybe Doctor Chen could give up research and move to a rural area and see patients.  That would help.

The headline of the UPI story reads “U.S. producing ‘abysmally low’ number of primary care doctors.”  The primary carelessness here is the false concept that primary care doctors are produced by the U.S.  They are not.  Primary care doctors produce themselves.  Young men and women choose – they are not assigned by the state - the noble calling of serving mankind as a physician (okay, it’s not as noble as being an RN, but it’s still pretty cool), and after university, medical school, and the layers of internships, residencies, and exams, are finally permitted to practice their art and science at about the time they develop grey hair and creaky joints.

Long before the middle-aged physician sees her first patient, she is burdened by enough debt to make even the most blasé Swiss banker take notice and dust off his amortization schedules.

Given that a physician might qualify for Medicare before she pays off her debts, why would she become a physician in the first place?  And if she does, should some GS-2 clerk be empowered to tell her where she is to practice?

We have all read narratives about how a surgeon bills $X cubed and squared for each hour of an operation, and have done the Gee! doctors-sure-do-get-paid-a-lot-thing.

But physicians aren’t paid a lot, especially general practitioners and double-especially general practitioners in rural areas.  The doctor saving your life made nothing for eight years of undergraduate school and medical school, and very little as an intern and as a resident.  Her need for food, clothing, and shelter did not take a hiatus for a decade, nor did the cancerous growth of debt.  The alternative to an accomplished surgeon would be having your appendectomy performed, as in the misbegotten Soviet Union, by a retired Red Army medic with a dirty scalpel in one hand and a bottle of vodka in the other, assisted by Comrade Fyodor with ether through an old lend-lease rubber mask.    

Beyond the years of preparation, the surgeon must pay her debts, her office nurses, her office staff (who spend their days quarrying through slurry pits of bizarre insurance and government forms), her loot-and-pillage malpractice insurance notes, and her taxes based on this year’s billable hours and not on the previous twelve or so years of accumulating nothing financially except encumbrances.

Our hypothetical physician is constantly monitored, supervised, judged, and faulted by insurance companies and by state and federal entities.

An insurance clerk, private or government, sitting behind a computer screen in Mumbai or Newark, is no more qualified to second-guess a physician than the physician is qualified to critique the welder joining a critical seam along the pressure hull of a nuclear submarine.

And yet it is so.  When you receive the heart-stopping bill for heart surgery, most of that bill disappears to pay critics and overseers, private and public. 

This nation suffers a shortage of physicians because no one wishes to spend years in education and training while amassing debt in order to begin work in early middle age and to be faulted and bullied for being good at what she does.

Healing is a wonderful vocation, from the physician to the RN to the LVN to the NA to the imaging folks and surgical techs and EMTs and the strange people in the laboratory and pharmacists and the nice fellow who cleans up the bloody emergency room at 0-dark-hundred in the morning.  None of these health-care professionals is a product.  Each one bases her (or his) life on getting you well and back to your house.

To discuss physicians as products, as units to be plugged into place here and there as some ideologue demands, is a bizarre detachment from reality.  To punish physicians for being physicians is national suicide.

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