Archives for: September 2014
The recent headlines about the death of Joan Rivers - in particular the alleged role of her otolaryngologist unauthorized to operate at the GI Endoscopy clinic where Ms. Rivers went into cardiorespiratory arrest - feed the theory that pursuing a career as an MD has transformed dramatically in our lifetimes.
I can remember meeting with many a doctor of my own generation, back in the late 1980s and 1990s, who said, "I'm getting out." Either early retirement because of their unwillingness to participate in the New Paradigm with its curbs on autonomy and excellence, or, perhaps for the less scrupulous, seeking employment/consultant positions with biotech/pharmaceutical companies.
For all the jokes, it may be fair to say that we were better off when, in and of itself, a clinical practice could be as lucrative as an ambitious physician desired. Thus it could attract those who enjoyed clinical work, interacting with people, sleuthing diagnoses, keeping abreast of the latest medical breakthroughs and research, paying careful attention to medications, and supervising assistants and office staff. Medical doctors could look forward to excellent remuneration for the tremendous responsibility.
Today (with third-party-hands on more of that remuneration), if Lucre is still an MD's objective, the name of the Game is: Gimmick.
"Procedurists" (seeing patients on Mondays - routing them into Procedures Tues.-thru-Fri.)
A Little Business On the Side (co-owning ambulatory "procedures" clinics with colleagues)
Competitiveness: "Be The Only One In Town Who..."
Celebrity photos on the wall
Performing procedures "backstage"
Administering anaesthesia at the patients' homes (remember that one?)
Taking unauthorized photos of an unconscious patient, with impunity (Doctor as Paparazza)
Waltzing into a surgery center with NO OPERATING PRIVILEGES and being treated like a star oneself
...Normal medical cautions be damned.
The phenomenon figures into the growing conviction of many that naturopaths and osteopaths, as well as other "alternative" practitioners, are safer to life and limb, which is 180º from the old saw that they were the Snake-Oil salesmen! Among this population, there could be not only increased safety, but greater health and educated participation.
In the PME (Pre-modern Medical Era), I had some very lovely Old School doctors with many famous clients. They were wealthy, but they were humble, careful, and friendly in the examining/consultation room. They were well-informed and gave very considered and conservative counsel to this non-celebrity. If a "procedure" were required, they had attending privileges at reputable hospitals they did not own. Never a soupçon of Conflict of Interest.
As the song said, "Those Were The Days, My Friend".
PS. Interesting: Two days after this blog posts, the following appears in The New York Times:
"The Famous Can Present a Minefield for Doctors: Joan Rivers' Treatment Seen as Possible Example of V.I.P. Syndrome".
Fall-out from some of the Gimmicks I describe.