by Seth J. Baum MD
Intending no disrespect to true war veterans, I will tell you that the 1980s was our Vietnam. As medical residents in New York City, the heart of the AIDS epidemic, daily we fought futile fights against the malevolent plague vanquishing our patients. Purportedly mild bacteria, fungi, viruses, and cancers found novel ways to torture and then kill their victims. Each day medical residents struggled to stave off the inevitable, the death of every patient. No one with AIDS survived the battlefields of the ‘80s. And they died in the most horrific ways. Blanketed in blue skin cancers, besieged by brain eating organisms, suffocating from ostensibly benign bugs, bleeding and clotting simultaneously and uncontrollably – in these ways they met their demise. But we – young, strong, and brimming with optimism – fought fearlessly and tirelessly, blurring the distinction between day and night. We never abandoned hope as we sat with these typically highly skilled, immensely successful young men, their mothers faithfully by their sides praying for miracles they’d never witness. Inescapably they all succumbed. The ‘80s were defining times. Though we acquired great knowledge as we fought, though we felt undeniable purpose as we struggled, though we wept silently as we lost battle after battle, we all knew that we were in the midst of something that would change us forever. Irrefutably we all suffered deeply and permanently. Still, we had a grand purpose. We knew that our skills, though failing to secure life for our patients, were still being put to their best use. We struggled, we cared, and we fought through extraordinary exhaustion. They were terrible times; yet, they were wonderfully unifying times. Patients, doctors, and even insurance providers worked as one. Contrast this with the battles facing today’s physicians. They could not be more divergent.
Today’s physicians spend 30% of each day completing onerous and often purposeless paperwork, entering data into patients’ electronic records, in order to comply with a crescendo of governmental and insurance decrees. Today’s doctors fight daily skirmishes far from the celebrated battlefields of yesteryear. Instead of sitting at the bedside, or examining spinal fluid to properly identify invading organisms and thereby reveal optimum therapies, or feverishly wheeling patients to and from examinations, our modern doctors sit in offices tied to phones with far-away physicians on the other end of the line blindly denying our well-considered medical recommendations. These shadowy ‘second opinions’ that hold our patients’ lives in the balance, work for insurance companies, not for patients. They never lay their hands on the suffering; they never look patients in the eye; instead they rely predominantly on paper – cold and one-dimensional medical records – combined with a tincture of understanding of an individual patient’s personal issues. Yet, their decree is gospel. They own the final word. These faceless far away guns for hire, quickly and often arrogantly preside over our patients’ lives. They, not your chosen doctors, determine whether or not you will receive potentially life-saving therapies. Instead of grappling with bacteria and cancers, viruses and protozoa, today’s physicians have been relegated to phone fights.
We lose invaluable time fighting other doctors, struggling over access to PCSK9 inhibitors, novel heart failure medications, imaging techniques for heart disease, drugs for cancers, and so much more. While insurer’s physicians hide behind the guise of guarding our nation’s capital resources, they disregard something far greater. They ignore the fact that by rendering medical opinions and directing medical care for patients they’ve never even seen, they violate our most honored oath, that of Hippocrates. Their therapeutic decisions hinge solely on economics, the cost of one treatment vs. another. This fact is easy to prove; if all remedies were equally priced, there would be no purpose for these insurance-retained doctors. With all the barriers that now stand between you and your doctor, today’s practice of medicine bears little resemblance to that which existed just 30 years ago.
It is time to recover the reins and reinstate the rules of yesteryear. It is time for all doctors to practice what we have been trained to do – fight for our patients’ health, using our hard earned skills acquired through years of rigorous training. It is time for patients and doctors to unite in the fight for patients’ rights. But time is slipping away. Now is the moment for an honest re-appraisal of the genuine insurance crisis facing many Americans. Let us open our eyes to the truth: patients and doctors are at the mercy of physician-specters, spell-bound minions of monetarily motivated insurance providers. Still, I assert it is not too late. We can reclaim the rights of patients and the doctors who care for them, those who face them and fight for them during their toughest times. Instead of abandoning hope let’s unite to recapture that which is rightfully yours and ours, the best care for you as determined by you and your chosen doctor. Let’s finally win this war and send doctors away from phone calls and back to the bedside.