they can and cannot do for their patients, and how much they will be paid for doing it. Put another way, if you happen to be the person being shipped from one ER to another because your HMO doesn’t perceive your illness to be life-threatening, statistics that say you’ll make it through your crisis without dying don’t mean a hell of a lot.
“In addition to biostatistics, I also took a course entitled ‘The Art and Practice of Medicine.’ That one I did do quite well in. Basically, what we learned about in the art and practice of medicine was people—not the kind of actors we saw in that movie, scrubbed and healthy and happy, but people who are sick . . . or injured . . . or confused—real people often at the very crossroads of their lives. People like Roy, a ten-year-old boy hospitalized by his pediatrician for profound malnutrition. Fifty-four pounds he weighed. It took an extensive, delicate evaluation, but finally the diagnosis of anorexia was made—an unusual though not unheard of occurrence in a boy of this age. Tube feedings and intensive family therapy helped the pediatrician and psychiatrist and nurses to save his life. Imagine if this was your child and he had died. Imagine the devastation to the survivors. But doctors doing what they had studied and trained to do kept that nightmare from happening. The point? Well, through a clerical mistake, Roy’s discharge diagnosis was listed as anorexia, not malnutrition. Same boy, same illness, same miraculous outcome, different word. Alas, whereas the family’s HMO would have paid for the lifesaving hospitalization if the diagnosis was written as malnutrition, the bureaucrats who decide such things adamantly and forever refused to pay for anorexia—a diagnosis they considered psychiatric, and therefore not covered by the family’s plan.
“Recently, Karen, a registered nurse in a hospital not far from here, with fifteen years of unblemished service, committed a fatal medication error. An investigation concluded that she was exhausted and harried because corporate cost-cutting had left her floor woefully short of registered nurses, and she had been picking up extra shifts and performing extra duties on those shifts. Do you think she or the family of the dead patient want to hear about statistics and dollars saved by substituting LPNs and aides for RNs?”
There was no movement at all among the hundreds in the audience. No sound. Will cleared his throat, then took a sip of water. Seated in the center of the fourth row, Gordon Cameron made eye contact and almost imperceptibly nodded. Will plunged ahead, feeling like a halfback who had broken through the line and was now running free in the open field.
“Last week a fifty-three-year-old loving, caring internist by the name of Mark White was chastised and threatened by a non-MD managed-care official for ordering excessive diagnostic tests on his patients. That call was the final straw for this physician, who had never been sued, who did volunteer work at a free clinic, who was a past chief of medicine at his hospital, and whose filled-to-overflowing practice was as totally devoted to him as he was to it. He spoke briefly to his staff and to the patients in his waiting room. Then he put on his coat and left. . . . Quit. . . . Just like that. . . . Good-bye, Dr. White.
“A survey by the
Western Journal of Medicine
recently reported that the average primary-care physician spends forty minutes a day dealing with managed-care hassles, mostly around referral and prescription issues. Since there are around one hundred thirty-seven thousand primary-care docs with managed-care contracts, that translates into more than twenty-one million hours of patient–physician interaction lost to those hassles. Using the average three visits per patient per year, and an overly generous twenty minutes per visit, more than twenty-one million patients could have had access to a primary-care physician during the time those docs are
“In addition to biostatistics, I also took a course entitled ‘The Art and Practice of Medicine.’ That one I did do quite well in. Basically, what we learned about in the art and practice of medicine was people—not the kind of actors we saw in that movie, scrubbed and healthy and happy, but people who are sick . . . or injured . . . or confused—real people often at the very crossroads of their lives. People like Roy, a ten-year-old boy hospitalized by his pediatrician for profound malnutrition. Fifty-four pounds he weighed. It took an extensive, delicate evaluation, but finally the diagnosis of anorexia was made—an unusual though not unheard of occurrence in a boy of this age. Tube feedings and intensive family therapy helped the pediatrician and psychiatrist and nurses to save his life. Imagine if this was your child and he had died. Imagine the devastation to the survivors. But doctors doing what they had studied and trained to do kept that nightmare from happening. The point? Well, through a clerical mistake, Roy’s discharge diagnosis was listed as anorexia, not malnutrition. Same boy, same illness, same miraculous outcome, different word. Alas, whereas the family’s HMO would have paid for the lifesaving hospitalization if the diagnosis was written as malnutrition, the bureaucrats who decide such things adamantly and forever refused to pay for anorexia—a diagnosis they considered psychiatric, and therefore not covered by the family’s plan.
“Recently, Karen, a registered nurse in a hospital not far from here, with fifteen years of unblemished service, committed a fatal medication error. An investigation concluded that she was exhausted and harried because corporate cost-cutting had left her floor woefully short of registered nurses, and she had been picking up extra shifts and performing extra duties on those shifts. Do you think she or the family of the dead patient want to hear about statistics and dollars saved by substituting LPNs and aides for RNs?”
There was no movement at all among the hundreds in the audience. No sound. Will cleared his throat, then took a sip of water. Seated in the center of the fourth row, Gordon Cameron made eye contact and almost imperceptibly nodded. Will plunged ahead, feeling like a halfback who had broken through the line and was now running free in the open field.
“Last week a fifty-three-year-old loving, caring internist by the name of Mark White was chastised and threatened by a non-MD managed-care official for ordering excessive diagnostic tests on his patients. That call was the final straw for this physician, who had never been sued, who did volunteer work at a free clinic, who was a past chief of medicine at his hospital, and whose filled-to-overflowing practice was as totally devoted to him as he was to it. He spoke briefly to his staff and to the patients in his waiting room. Then he put on his coat and left. . . . Quit. . . . Just like that. . . . Good-bye, Dr. White.
“A survey by the
Western Journal of Medicine
recently reported that the average primary-care physician spends forty minutes a day dealing with managed-care hassles, mostly around referral and prescription issues. Since there are around one hundred thirty-seven thousand primary-care docs with managed-care contracts, that translates into more than twenty-one million hours of patient–physician interaction lost to those hassles. Using the average three visits per patient per year, and an overly generous twenty minutes per visit, more than twenty-one million patients could have had access to a primary-care physician during the time those docs are
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