The following letter, which I sent to a young man who sought and finally achieved entrance to medical school, I think, would be of interest to the readers of the Medical Sentinel, for it reflects some of the problems we are facing today in medicine.
Congratulations on your acceptance to medical school. It is an acceptance, I think, that has been well worth your wait of three years. The great journey now begins.
I must apologize to you for the current state of affairs in “medicine.” We still look to an unchanged leadership of “good ole boys” who react with what we call a retroactive pattern to massive change in health care delivery. Zealots were never tolerated, and when push came to shove, and when we needed zealots, the “good ole boys” wouldn’t move over. Subsequently, things are in a hell of a mess in the House of Medicine. Younger physicians whose incomes have been brought down are beginning to rise to the occasion and become vocal and vociferous and, I predict, soon will be in charge of many of the “good ole boy” organizations. These organizations, like the AMA, will be swept out of the way and replaced by new ones (AAPS). If the curmudgeons are not totally swept out of the way, their roles certainly will be diminished. Proactive leadership will emerge to sail us (medicine) into the 21st century. For medicine’s sake, it needs to be so!
Physicians have always been held in high regard by society because of their caring for other persons. We are still the number one chosen profession and take heart in that fact. Your skill, compassion, and medical training will serve you well for many, many years into the future.
In the last two or three years, with health care costs leveling out, our patients are being literally hurt by corporate medicine and they are rapidly becoming dissatisfied. New medical devices which used to come quickly because of the expanding economic marketplace, are now rare. When I began in medicine in 1962, one would almost never get to see a 90-year-old patient and rarely an octogenarian. People did die often in the 50s and 60s. Now, in 1996, 80-year-old patients are common place in any practice. We doctors have made a difference, armed with new technical tools that have proliferated by the economic necessities of getting ahead of the next guy and saving lives and stamping out disease. These rapid developments will no longer occur because of the changes in the economies of health care delivery, I predict.
While many of us feared socialization of medical practice from the government, we did not anticipate a literal socialization by the insurance industry. California, however, a week ago, had 1.5 million persons sign a petition to limit HMOs. A recent major study of the Employer’s Council noted that 89% of American workers had some form of health care provided, but fully 53% were dissatisfied, and women, as a group, had a remarkable dissatisfaction rate of 58%. Older workers, of course, who use the system more frequently, were much more dissatisfied than younger workers. They are currently the major consumers of medical care. The stimulus for change is there and it is beginning to point towards the direction that medicine was once headed.
My point and message to you is to revere (and emulate) older physicians in their ability to handle the clinical practice of medicine, but look to yourself and younger physicians for establishing a proactive leadership that will allow us, unencumbered by bureaucracy and the insurance industry, to take the best care of other human beings. This is what our calling is all about. Don’t forget it.
In the words of my teacher, Dr. Tinsley Harrison (Harrison’s Textbook of Medicine), “you either practice the highest type of scientific medicine, or quackery.”
Cordially and fraternally,
Jacob Green, MD, PhD
Dr. Green is a board certified neurologist in Jacksonville, Florida. His address is 3728 Philips Highway, Suite 31, Jacksonville, FL 32207.
Originally published in the Medical Sentinel 1997;2(1):36. Copyright ©1997 Association of American Physicians and Surgeons.