ne of my attending physicians on the ENT service chatted a bit the other day about the sad state that our country's medical system is in (among other topics). It's a discussion that I've had more than once with a variety of people and even though it's a repeat conversation, I still am very bothered by it.
I am bothered by the fact that what I see across various specialties and subspecialties is this sense of entitlement and a misguided idea of fairness. To a lot of people, they are "entitled" to low-cost/free health care. They want major operations that take 8+ hours for next to nothing. They complain about the high cost of health care and bitch about the "disgustingly high" doctor's bills that they get in the mail without even realizing that doctors don't see the majority of the money on that bill. For example, depending on reimbursement rates for the INSURED (and that's the INSURED, mind you...) if a patient receives a bill for $5,000, the doctor might only receive $1,500. The rest goes to corporate america and the CEOs and other middlemen that have infiltrated the medical profession at the behest of the government.
Part of the problem is that people are willing to pay top dollar for what they consider necessary. People pay huge amounts of money to plastic surgeons so that they can have those butt implants to ensure that they'll never find a pair of pants that fits correctly again. They pay to suck fat from their upper arms that could have been removed by a $50 gym membership. They want collagen in their lips and silicone in their chest. They'll happily pay $20,000 for a few minor procedures that leave them looking like they've decided to go as Joan Rivers to the company Halloween party. And yet, when they find out that their unhealthy life styles have made a coronary artery bypass necessary...they don't want to pay. They think it should be free. In the minds of many people living in this country, it's more worthwhile to pay $25,000 for an endoscopic brow lift with laser resurfacing and a touch of lipo than it is to pay $25,000 to fix their heart and buy them more time on this planet. It's frustating.
I look at it this way. I love my car. I love it for a variety of reasons, not the least of which is that it drives me around and gets me to places I need to go...such as work, so that I can pay for the roof over my head, the food in my belly, and the clothing that keeps my out of shape body covered. If I were driving along on the freeway one day and my car began to sputter and jerk before descending into the final death throes that cars will randomly engage in from time to time for no discernable reason, I would be unhappy. In fact, to the repair shop I would go posthast. I might balk and gasp when the mechanic announces that there are problems with the engine/transmission/fuel pump/etc that will cost me roughly $4,000 to fix. I might think very rude and unlady like thoughts in my head. But the bottom line is that my bank account will become $4,000 lighter, not because I truly want to pay the mechanic that much, but because it's my car and I need it. I don't bicker with the mechanic. I don't tell him that I am somehow entitled to free car service. I don't refuse to pay him the $4,000. He takes my money, spends an hour doing whatever it is that he does to the innards of a car, and I drive away in a car that once again does what it is supposed to do.
My point is this: we don't hesitate to pay the mechanic to fix our cars. We'll pay obscene amounts of money just to get a fuel line fixed. We'll do whatever it takes because it's important. We'll wait hours and hours for the TV repairman to come fix our televisions so that we don't miss the Thursday episode of Grey's Anatomy. Yet when it comes to our healthcare, we expect it for free and we get mad and refuse to pay "on principle." WHAT PRINCIPLE IS THIS? You'll pay the mechanic to work on your engine/TV repairman to fix your LCD flat screen TV...but you won't pay the doctor that grafts a new vein into your heart so that you can be around to watch your son play his Little League game or walk your daughter down the aisle. Help me to understand how my time is less valuable than the time of a mechanic and how my daily activities are less important than making sure ABC comes in clearly on your television.
Understand this, people: NOTHING IS FREE, and healthcare shouldn't be any different. I do keep in mind that healthcare costs are too high. That's not the fault of doctors, it's the fault of government created middlemen that have changed the way medicine is practiced. If government had less influence in medicine and middlemen weren't paid so much to sit behind their desks, medicine might very well be a cheaper undertaking. I don't have any easy solutions to the problem. Actually...I don't have a solution period, because I'm busy. I've been busy for the last six years and I'll be busy for at least the next 40. I've been busy learning how to be a good doctor - the kind I'd want my parents to go to. I've been busy spending 10 hours a day studying for the last couple years. Right now, I'm busy working almost 80 hours a week, sometimes nearly 30 hours straight, so that one day I'll be able to save your sorry butt. I see my family for maybe two weeks out of each year because my schedule is a little full and if you don't think I miss them, you're sorely mistaken. I'm busy enough that conversations with my best friends are limited to messages sent through MySpace, because I just don't have the time for phone conversations. I spend 12 hours a day wanting nothing more than 30 minutes to visit the loo and the cafeteria, and at night when I dream, I dream about sleep. I lose sleep and I stress out and sometimes I cry from exhaustion and despair, sure that I'm never going to be the kind of doctor worth having. I'm busy caring about you, even when YOU don't care about you, and to be quite frank with you, I get quite disgusted when you throw a hissy fit because you don't think you should have to pay me. If you refused to pay the plumber, you'd have to figure out an alternate method of showering because he doesn't work for free. If you told him "I know you asked for $1,000 but I only feel like paying you $250" he'd laugh all the way out of your front door and you'd still have a broken toilet. Yet when you do the same thing to doctors, you walk out of that OR with a new heart. You want the latest, greatest technology for pennies on the dollar, and that is not fair. It's not fair to us, and it's not fair to you. People complain that the standard of medicine has fallen even though costs have risen, and some who receive low-cost/free healthcare complain that they get sub-standard care. It's trite but true, even in medicine - you get what you pay for, and when you pay for a lower standard of care, that's sometimes what you get. The impetus for something better is missing. I'm not saying that things should work that way; I didn't go into medicine to give shoddy care - nobody does. But it's happening all over the replace, so I'll repeat myself: this current thinking pattern is not fair to us, and it's not fair to you. In fact, it's so not fair that America currently has only 75% of the physicians that it needs, and it's only going to get worse. Medical school enrollment rates are starting to drop. Not all those who start medical school finish, and not all those who finish decide to practice medicine. There are a variety of reasons for this, but I would be remiss if I didn't say that the current state of medical affairs wasn't among those reasons.
I think it's about time you get your priorities straight, people, or one day there won't be a surgeon to fix your heart or a pediatrician to heal your child's ear infection. You'll be up a creek with without a paddle - and don't expect your expensive tummy-tuck to pitch in and row you to safety.