Wednesday, July 22, 2009

I feel dirty.

I have spent the majority of my adult life pursuing and practicing medicine. I think I'm pretty good at it. I certainly try to be, at the very least. I feel sure that I've helped some people. I feel relatively sure that if left alone, without somebody hovering over my shoulder, watching my every move and scrutinizing my practices to ensure that I am using their particular version of "best practices", I'd still treat my patients like I'd want to be treated. I practice medicine the way it was taught to me - as an art as well as a science.
Want to know a secret? Picture this: two patients, about the same age, with about the same complaint. Ready for the shocking medical truth? I may not treat these two people exactly the same. Infinite variables exist, which guide the decision-making with regard to the way I speak to the two different patients, the medicines I may prescribe, the education I provide to goes on and on. That's why medicine can only be properly practiced by a living, breathing human doctor.
This is surely offensive to those who believe that medicine can be reduced to a series of algorithms; who believe that the best treatment for a particular condition must necessarily be the one that is cheapest and most efficient for the collective. By this logic, the most "efficient" medical care would undoubtedly be practiced by a computer, which can stick to the now-worshipped "evidence-based" algorithm with a ruthlessness that can never be approximated by even the most devoted human practitioner of "cookbook medicine".
Because I reject this notion wholesale; because I believe that what I do matters; because I want to help my patients to live better lives, even if it is expensive sometimes; and because I have spent my life trying to be worthy of the kind of trust I see in the eyes of a terrified mother with a sick infant, in the eyes of an elderly person gasping for air, in the eyes of a family who knows that one of their loved ones is dying - because of all this and more, I feel dirty, violated, and sickened when I hear our President saying the things he presumed to say tonight on TV.
To suggest that a typical doctor, faced with a child with a sore throat, would seriously contemplate subjecting him or her to a tonsillectomy simply to secure a higher reimbursement is the most disgusting sort of lie. I shouldn't be surprised. He has never been afraid to lie to accomplish his infernal objectives before. But this time it was more personal. He's been very careful not to alienate doctors in the past. He is counting on us to be good little soldiers, taking whatever he decides to give us for our work, and make this big socialist vote-buy possible. He tipped his hand.
What he feels about us is now painfully clear for all who will care to listen to his words. Left to our own devices, we doctors are opportunists - seeking to parlay our education and skill into filthy lucre even at the expense of our patients' safety...especially at the expense of our patients' safety. The mere suggestion should be disgusting to any decent doctor. That this sort of suggestion would be made in the context of his attempts to undermine our hard-won relationship with our patients so that he can ram his socialist agenda down our throats is more than "politics as usual". It is a violation of the most hideous sort. Pot, meet kettle.