A Trial Lawyer's and Patient's Perspective on Doctors and Health Care
"Molière saw through the doctors, but he had to call them in just the same."
"It is not reasonable, to expect doctors in private practice to be impartial when confronted by a strong pecuniary interest."
- George Bernard Shaw
As one who has had either the fortune or misfortune of being a personal injury litigator, depending on one's altruism or lack thereof for over 43 years, I have reached some inevitable conclusions concerning the individuals who could stand the sight of blood and therefore embarked upon a course of deriving a benefit from the maladies of others.
How this exalted professional status has struck social observers over the years varies with the intensity of their individual experiences. George Bernard Shaw's outlook was somewhat malign toward the medical profession, observing that, in the "Doctor's Dilemma,"
"...when doctors as competitive tradesmen were replaced by a medical profession that had been brought under responsible and effective public control. Until this body of men and women were "trained and paid by the country to keep the country in health it will remain what it is at present: a conspiracy to exploit popular credulity and human suffering".
In other words, Shaw was looking forward to the creation of a National Health Service." These words were written in 1903.
Not that lawyers are not calculating; however, they are constrained by the law and by their profession itself to simply presiding over the transfer of wealth from one party to another, providing the oil for the cogs of either justice or of criminality to function or not. Many are just as greedy as anyone else, but generally, people's lives do not depend upon their behavior. Their fortunes, yes, their freedom, often, but, except in rare criminal cases, not their lives.
Much of the angst that Doctors suffer, depending upon their conscience, individual character, or profit motive, fear of being sued, or other governmental intrusion upon their fiefdoms depends upon how motivated they are by greed. Often the ones who are greedy usually occupy large private medical groups and are judged within that group by how many patients they see, or how much revenue they generate. Usually the ones affiliated with Universities and are academics are somewhat less motivated by such obsessions. Some doctors are so greedy that they refuse to write prescriptions for patients who do not come in for a visit at which time they can be prescribed almost anything they want, as long as the doctor can bill either Medicare or a private insurer for an office visit. If a patient calls and asks for a renewal, the doctor insists that they visit or get no prescription, blaming the government in most cases, of non-existent governmental scrutiny. Some will not even fill out a form without a fee being charged to the patient. Patients resemble a stack of Benjamin Franklins to them. Questions concerning such matters with the doctor often evokes an aggressive, "find another doctor" rebuke. Such an enormous ego or insecurity does nothing for the doctor-patient relationship. One doctor was offended by my asking for test results after waiting 10 days. No concern for the patient's anxiety evident at all. "That's normal for this office, if we are not meeting your needs, find another doctor."
In addition, my individual experiences with doctors who testify in court enjoy more popularity if they are the most convincing witness no matter the mendacity of their testimony. Some doctors who specialize in forensic medicine, charge highly extravagant fees, based upon the rationalization of loss of net patient visits when they are obliged to visit the courthouse or to give deposition testimony. Every fundamental lesson of cross-examination of these doctors requires questions of how much they are paid for their testimony, what percentage of their practice is dedicated to treating patients, and how often they are in court (often more than in the office) and for which side they testify, how many patients they actually treat, etc.
Some have robotic administrative staffs specifically geared to make sure the doctor is or will be paid before he or she even consents to treat a suffering patient. They have insufferable office managers trusting no one, their jobs set by the culture of the office promulgated by the greedy doctor rather than the needs of the patient, affirming the 1903 Shaw philosophy that doctors should be working for a National Health Service. Illness should not be profit driven and insurance companies whose motives to collect premiums and not pay claims remain insidious affronts to a decent society. The same rule should apply to physicians who run their offices as though they were branches of the Bank of America.
Some argue that health care needs physicians profit motivated to make decisions concerning the patient's health and that it attracts people of quality to this profession. Studies in European nations like Sweden debunk this notion. Compounding this error is the health insurance industry, stories about which circumlocutions to a avoid legitimate claims are often featured by investigative reporters and on "60 Minutes."
Doctors who seek fabulous wealth should be in business, not clinicians; they deserve to earn a good living commensurate with their hard work and training. But a profit motive for a clinician simply works to the detriment of the patient. And a profit for a health insurance company is the same evil on steroids.
No possibility of great change in this system is possible unless the public is disabused of the notion that clinical medicine is a business. Clinicians perform great service to society, but usually perform no research and development. If they do, they are entitled to patents for their work.
Then they can reap the rewards of entrepreneurship. Otherwise, let them earn a good salary, live in a nice home and stop acting like they do not belong to a noble profession, dedicated to their patients, and not to large boats and McMansions. Leave that to the titans of industry, or as Theodore Roosevelt aptly put it, to the "Malefactors of Great Wealth."