Columnists > From the Publisher

Unhealthy expectations

Patients and doctors together need a shot of reality

Issue: "Drawing the Line," Feb. 22, 1997

The medical profession, for all its vaunted place of privilege and power in society, continues to take it on the chin. And in the wallet: Doctors' incomes are generally down; although that may not prompt tears in most places, the implications are big.

For those smaller incomes, physicians are experiencing new levels of frustration with a paperwork load that suffocates the work they're really called to do. Imposed by insurance companies and government, forms have become the bane of the profession. I regularly ask folks, &quotIf you could go back and make your vocational choice again, knowing everything you know now, would you pick this one?" I'm stunned at the number of physicians who say no.

Yet patients too have added to that discontent. By most accounts, malpractice suits--whether real or threatened--shape way too much of actual medical practice these days. I heard a Christian physician a few days ago describe the emotional baggage he carried for a year because of a suit that never even went to court. Still, during the period before the plaintiff dropped the charges, my friend wrestled day in and day out: &quotI knew I had done everything I could in the case; I knew I had done nothing wrong. Still, I was being sued for something clearly beyond my power--and I couldn't help thinking: Is it really worth it?"

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Doctors in this new age face still another regular insult--from New Agers, of all people. Perhaps it's always been the case that herbalists, reflexologists, irridologists, acupuncturists, and a holistic host of others have stood by with their exotic cures for ills that regular doctors couldn't handle. Now it's startling to note how many folks--including evangelical Christians--are turning to such mystic sources for healing.

Not that I think we need to load the nation's doctors into an ambulance and rush them off to the emergency room. They're a hardy bunch, and they'll survive with a little first aid. But in the process, both patients and doctors ought to learn some lessons.

We health care buyers need to learn to treat health care providers a little less like gods. Our tendency to over-reverence our doctors has made the situation worse in three distinct ways:

(1) We overuse their services. It's hard to deny the law of supply and demand. Our national habit of running off to the doctor at every sniffle, asking him to prescribe something fast, is very expensive. Use any resource twice as often as you need to, and you'll drive the cost up. Do it with a relatively rare resource, and you'll drive it up dramatically.

(2) We see good health as a right. But simply imagining a right doesn't make it a reality. Most of us would also like the right to live in big mansions, have servants, and drive luxury cars. But only a few people get those privileges--and the rest of us tend to accept that reality. Oddly, the same kind of acceptance doesn't apply to issues of health. Encouraged by a welfare state, we've all come to think that cradle-to-grave health care--at any cost--is part of the &quotlife, liberty, and pursuit of happiness" guarantee.

(3) We get angry when the gods we've created don't come through. Such anger is evident when a medical procedure doesn't go just the way we wanted it to, too easily prompting us to sue. It shows up again when the cost gets beyond our reach, either individually or societally (as in the present debate over Medicare). So we assert ourselves again, and remind everyone that if these gods don't produce, we just might start looking for gods who will.

In all candor, however, the medical profession has too often fostered these attitudes. Fallen human nature prompts even good people to enjoy being thought of more highly than they should.

So when we hustle ourselves off to our doctors for quick fixes, maybe they should be a little less quick to prescribe antibiotics that they know full well have little or no chance of doing any good. Even when we insist that we want such magic bullets, more doctors need to take a bit more time to remind us that no such magic exists--and that they are mere mortals like the rest of us.

Is a medical education arduous? Of course--and we applaud those who exercise the discipline needed to complete an M.D. Are doctors' skills rare? Yes, but it might be easier to find a skilled retinal specialist than a skilled Christian college dean. Are doctors' hours long? I know Christian school teachers who work as hard. Is the pressure oppressive? Talk to the pastor of a growing church.

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