Dr. David Lipschitz Recently,
a giant in the field of medicine, Dr. Thomas E. Andreoli, died. He will be sorely missed. His obituary described him as unashamedly
"old school"; honor, integrity, service, the needs of the patient and scholarship were his highest priorities.
In Andreoli's day, physicians were well-paid, but mercantile issues were never a serious consideration. All physicians
were valued equally and played unique roles in patient care; there were no wide disparities between the value of a primary
care doctor and the value of a subspecialist who performed sophisticated procedures to diagnose, treat and, yes, cure disease.
How things have changed.
Today medicine is a business, and the bottom line has become ever-more important. The
most successful physicians are entrepreneurs who understand how to run their practices focusing heavily on profit. These entrepreneurial
physicians band together as subspecialty and multi-specialty groups, creating an all-inclusive model in which profit is generated
from the fees for not only hands-on patient care but also the array of tests that are ordered so readily on every patient.
These groups typically own their equipment, as well as the facilities, and make profits by ordering blood tests
and imaging studies, such as CT scans and MRIs. Based upon the results (for which the fees are quite handsome), more invasive
procedures and expensive therapies often are recommended. The more these doctors do to each patient the more they make.
Here is a typical example of this "new school" form of medicine:
An 82-year-old woman goes for
an annual physical to her internist, who is a member of a large multi-specialty group. After a five-minute visit with a nurse,
during which a few questions are asked, this patient has a series of laboratory tests, an electrocardiogram, a stress test
and an echocardiogram.
Because she did have some heart problems, those tests automatically were performed annually.
The cost to the insurance company and reimbursement to the doctor were substantial. Three weeks later, the patient returned
for a 10-minute follow-up visit, all to say she was doing well.
There is absolutely no evidence to suggest that
such aggressive tests should be performed annually on a patient her age -- regardless of her pre-existing condition. Was the
doctor overly aggressive simply for precautionary measures, or did he intentionally profit from ordering so many tests? We
can only guess.
I could write a book filled with examples of care that I and most other rational physicians would
view as unnecessary. In the "old school" days, those practices were extremely rare. As more and more patients become
aware of this glaring problem in the medical community, it is no wonder that health care providers are losing the public's
trust.
While everyone seems to agree that this "new school" form of medicine is not working, physicians
are playing a very small role in health care reform. And, I'm sad to say, the physician's current role in the reform debate
largely has been to ensure continued payment for the latest, most expensive care (which conveniently protects the bottom line).
In the future, this could have a disastrous impact on patients. Without major systemic changes to the reimbursement
system, any cuts to individual health care services will likely prompt physicians to do more unnecessary care simply to stay
afloat. In the end, the medical system will fail, and health care may emerge in a drastically different form, with few opportunities
for innovation, discovery and finding cures.
I urge all physicians to think about the "old school" days.
We must regain public trust by being responsible, honorable and ethical, and we must do everything possible to follow the
right path. We must work toward only practicing medicine that is truly necessary, educating our patients and being accountable
for containing costs.
In the "old school" days, a leader like Tom Andreoli would identify the solution
and never relegate that responsibility to politicians, public policy experts and others who have no hands-on patient care
experience. It will take leaders like him to ensure that medicine remains a noble profession, meeting the needs of the population
without breaking the bank.
