Thursday, February 28, 2008

Doctor, my eyes have never seen the coming of the doctor

For a while, when my brother and I were young, our pediatrician was Robert Mendelsohn. If you read his Wikipedia profile, you're left with an impression of a gadfly, a man who got himself in trouble for opposing things we all regard as routine (such as coronary bypass surgery and casual X-rays). He was not loved by others in his profession.

But I remember a kindly man who treated a couple of children with respect. Mostly I remember a doctor who actually made house calls. For those younger than I who don't know that term, there was a time when the family doctor would actually come by the house when someone was sick.

Now when you're sick you drag yourself to the office, if you can get an appointment, you run the risk of infecting everyone else, and, quite often, you diagnose yourself. Heaven forbid your problem doesn't fit into the time allotted; your list better be covered in a few minutes or it's out the door, prescriptions in hand.

A friend of mine underwent surgery last week, a fairly trivial arthroscopic procedure. Now, on day 9, there is still quite a bit of swelling, not just near the incision at the knee, but in the nearby parts of the leg. My friend called the doctor as indicated on the post-surgical instructions. No surprise, all interactions have been through a nurse - allegedly she's talked to the doctor.

We can talk all we want about various ways of improving health care in this country. Every candidate has a plan, and there are other options, like single-payer, that aren't considered politically feasible.

But all these plans talk about how to fix the payment problem, how we can get people a certain minimum standard of treatment. None of them talks about the "care" part, about how we get doctors to be engaged in the healing of their patients. Do I expect house calls to come back? No. But I do think we can return to the point where doctors see their patients not in terms of increased capitation, but as people who are scared that they won't be able to return to their lives, who will see the quality of their lives inexorably decline.

Doctors get pretty good treatment in our society. Their compensation is rarely mentioned as a factor in high health care costs, though it certainly is. Television shows portray them as magical, caring healers who bravely overcome their massive personal problems to create miracles. It certainly doesn't seem unfair to expect society to be well-treated by its doctors.

No comments:

Clicky Web Analytics