Over at Dr. Roy Poses’ Health Care Renewal, contributor Anne Peticola offers a post titled: An Outsider’s Take On American Medicine.
She writes: “Jonathan Kaplan’s The Dressing Station was published in 2001, but I am only reading it now. Much of the book is about battlefield medicine, but one part concerns his coming from Britain to America in the late 1980s. . . .With research budgets cut under Thatcher, he came to America to be able to pursue his medical career.
“After his dreary British experience during a period of budget cutbacks, he greatly enjoyed the cheerful commercialism and general prosperity of American medicine. He promptly found a research project to work on that would enable him to write a Master’s thesis, and the work was fun and went swimmingly.
“Nonetheless, Dr. Kaplan was quite disconcerted by some of the differences between British and American medicine. Working on another study, he reviewed hemorrhoid surgery results. He was startled to realize how much more surgery was done for minor piles in the U.S. than in Britain, though results were unimpressive – then ‘I found the payment invoices in each patient’s folder. These were met by the health insurers, who paid out a lot more for an operation than injections. . . . The logic of a for-profit system appeared to lead to expensive solutions and spiraling costs.’
"He was also startled by anecdotal reports of how the stock market crash of 1987 led one surgeon to actually shed tears mid-surgery when he heard the news. As well, the serious, money-oriented medical students surprised him, as he was used to quite a number of more arty, intellectual types among medical students in other countries."
Criticism of American physicians for being too money hungry? This must surely be breaking new ground here on Health Beat.
Dr. Kaplan was startled by ANECDOTAL reports of a surgeon crying upon hearing of the ’87 stock market crash? Dr. Kaplan, keep up that hard hitting research – keep your ears open for more anecdotes!
Legacy Flyer–
The post wasn’t so much about greedy physicians as it was about a system set up to make profits rather than to meet the needs of patients.
The serious point of the post comes in the comparison re: surgery. And if you went to Poses’ site, you would find this story about device-makers in the end of the post:
“Still, he was thrilled about his promising research results on a heated balloon angioplasty device. Later, he was disillusioned to hear that after the device received FDA approval, the main competitor, a laser manufacturer, bought out the idea and shelved it to keep it off the market.
“I thought his observations fit well with Dr. Poses’ concern about insidious corruption in medicine and too many physicians who don’t feel the expected fiduciary responsibility to patient welfare.”
Btw, I remember reading about the weeping surgeon in the papers at the time of the ’87 Crash. Struck me as funny, in a very dark way.
Then there’s the story of the surgeon who decided to go to the bank during surgery (I know this one is true because I wrote about it myself.) He was gone for a long time–(probably a long line at the bank) –and something went awry with the surgery.. . .
There are some Canadians that have a certain clinic they like or doctor they like that is a tradition in going back and forth across the border with the United States. But according to the Canadian government, 85% of Canadians like the health care they are receiving in Canada. You don’t see long lines of Canadians in health care clinics in Detroit.
A former Ontario health and economic minister notes that Canada spends more than a third less per capita on health than the United States and still covers “everyone,” wheras the United States system leaves 47 million people without insurance. In Canada, doctors do not have to waste time seeking insurance approvals. Medical need is the only requirement, and pre-existing conditions don’t matter.
When it comes to making coverage decisions based on medical evidence, for-profit insurers have a pretty spotty record. In the 1990s, when insurers said they were trying to “manage care,” many were simply “managing costs.” For example, some decided which drugs to include in their formularies based simply on whether the manufacturer would give them a deep discount. In return for the discount, the insurance company would assure the drug-maker that it would not cover a competing product. This had nothing to do with which drug was more effective.
The public will always be suspicious of decisions made by for-profit insurers even when their decisions are based on sound medical evidence. For-profit insurers just don’t have the political or moral standing to make these judgments. By contrast, most patients are much more comfortable with Medicare’s coverage decisions which is why we need a federal agency (MedPAC – an independent group that advises Congress, but give it some meat behind it) testing and comparing the effectiveness of new treatments.
In the meantime, your family doctor has to become an employee of your local hospital, instead of being independent. And you’ll continue to have a corporate bureaucrat between you and your doctor.
I remember researching (i.e. – listening to anecdotes) how papers are graded while in college. At my college a paper was returned with the following comment: “There is much in this paper that is interesting and much that is original, however what is interesting is not original and what is original is not interesting – C-“. That sums up my opinion of the August 3rd post.
Citing an anecdote (probably an “urban legend”) about a surgeon who wept when he found out about the stock market crash of ’87 is a similar to talking about “Welfare Queens” driving Cadillacs in a discussion of poverty – it is a rhetorical device meant to generate more heat than light. Do we start a critique of the state of journalism by talking about drunkenness and plagiarism? I am sure that there are anecdotal reports of journalists writing article while drunk and there are documented cases of journalists plagiarizing other’s work – how representative are these stories of the field in general?
I went to Poses’s site. I am familiar with the issues surrounding “laser angioplasty” having performed quite a few angioplasties myself. As for the heated angioplasty balloon vs. the laser angioplasty balloon they are in fact the same – the laser is merely used to provide heat. In fact, neither of these procedures has stood the test of time and as far as I know is not currently used. In essence, Dr. Kaplan’s product failed the test of “comparative effectiveness”.
With respect to another “urban legend” promoted on this blog – a pilot cannot report a “near miss” with no repercussions. Recently while at Oshkosh (EAA), I spoke to 3 airline pilots and one ATCA representative about the reporting of “near misses”. Although it is true that there is a culture of safety in the airlines it is not true that a pilot can report a near miss with no repercussions. This is consistent with my own experiences. This “urban legend” shows a serious lack of understanding about how ATC, the FAA and the Airlines actually work.
Finally, and on a more pleasant note – I am most of the way through your book and think it is quite good. I have some quibbles with various parts, but for the most part I think that it lays out many of the issues quite well.
Wonderful article, thanks for putting this together! “This is obviously one great post. Thanks for the valuable information and insights you have so provided here. Keep it up!”
Extremely long but very useful and informative article. How i wish i can do all of that in a short period of time. But for sure doing those will produce results. I will try to spread your words through my blog and link it back to you. Thanks a lot for those tips.
Btw, I remember reading about the weeping surgeon in the papers at the time of the ’87 Crash. Struck me as funny, in a very dark way.
The post wasn’t so much about greedy physicians as it was about a system set up to make profits rather than to meet the needs of patients.