What Happened to the Doctors?
I read with great interest and increasing dismay your recent “Who’s Who in Health Care” (July 28). After reading the profiles of your 50 selected industry leaders, I was appalled to realize that less than 20 percent of those individuals were physicians.
It seems quite clear that in this era of managed care, the sacred doctor-patient relationship has taken a back seat to the business management of health care delivery. Patients have now become “capitated lives,” while doctors are referred to as “providers.” The special relationship between the physician and the patient has been obscured by the presence of utilization review staff, pharmacists, medical directors, chief executives, and, of course, shareholders.
This arrangement has given an entirely new and haunting meaning to the oath every physician takes, “First of all, do no harm.”
Physicians traditionally complete up to 12 years of additional training after graduating from college. Yet, today health care decisions are being made more and more by attorneys, accountants, advertising executives, quasi-professionals, and administrative staff who have absolutely no training in medicine. Managed care is unquestionably here to stay; the only issue that remains to be settled is what form it will ultimately take. Physicians have become increasingly frustrated and confused by the downward spiral for reimbursement for their services and the ever-increasing array of bureaucratic requirements imposed by the multitude of health plans.
My discomfort with your profiles is exacerbated by the fact that I personally know some of these individuals. If they, in fact, constitute the leadership of our professional health care delivery system, then the pendulum has, indeed, swung way too far in the direction of the robber barons. While these individuals unquestionably have special talents, those talents are not always consistent with the qualities required for health care delivery and patient care.
Unless physicians begin to work together to address these issues, the pendulum will continue to swing in this abnormal direction. As your failure to recognize that our community’s outstanding, leading physicians make up the real “Who’s Who in Health Care” would suggest, we may soon witness a health care delivery system in which “capitated lives” and “providers” become mere statistics to be manipulated to improve the bottom line.
GREG ANDERSON, M.D.
Inglewood
