An osteopath criticizes the American Iatrogenic Association and we respond
On 30 April 2002, we received the following two messages from a man who identifies himself as an osteopath (and whose name we are withholding). His comments offer striking insights into the present miserable state of medicine. He is obviously quite upset with his work, his life, and medical critics. Even though our organization is the subject of his immediate irritation, and we feel his anger is misplaced, there is truth in what he says. Much of the joy has gone out of practicing medicine.
On the other hand, some of his expectations seem to be unrealistic, and his values askew. For instance he asks, "What rewards are there for giving up one's life to care for the medical needs of others?" All of life consists of choices. To select one path is not to "give up" another. One chooses what one desires if one is wise. It has long been the case that the practice of medicine demands a lot of time, but the devotion of that time is chosen. For more leisure time one becomes a retail clerk or an insurance agent.
So, this man chose to become a doctor, and he is not happy. He says he is heavily in debt and that the Medicare reimbursements are poor. Accepting that both are true, he deserves sympathy for neither. He assumed the debt voluntarily, and taxpayers probably also heavily subsidized his education. As he laments, he may be living a "modest life," but the average income for his profession is still well above average. Medicine is business, and it is his responsibility to ensure that his business is run profitably. Accepting Medicare patients is not a profitable choice, as is widely known. He is correct that Medicare reimbursements for treatment are pathetic. But he chooses to do business with the government against the advice of organizations like the Association of American Physicians and Surgeons.
It is also true that he is a member of a licensed cartel. The government artificially controls the supply by limiting the number of medical school graduates, thus inflating incomes and costs to consumers. It limits the number of immigrant doctors who can practice in the U.S. It prevents other healthcare professionals, such as nurses and midwives, from performing tasks now done by doctors. The State gives doctors virtually an exclusive right to dispense drugs, forcing people to pay for office visits to obtain medications that can be obtained without prescription in many countries. It brings lawsuit against people who dare to compete by offering "alternative" treatments (whatever their value). In short, only lawyers are afforded as much legal protection against competition and assurance of high incomes as doctors. This should not be construed as our having resentment against wealth. We are happy that anyone obtains whatever honestly gained riches he might in the free market. (To be honest, many critics of medicine are afflicted with class envy, just as many doctors are afflicted with class snobbery.)
He is right to be scared of lawsuits. There are too many unmerited lawsuits. Lawsuits rarely improve the quality of medicine and are increasingly harming it. If he practices with diligence, he shouldn't have to worry about being sued. But today, the other cartel, the attorneys, have the upper hand and know that doctors (through their insurers) have deep pockets. Some reasonable limits have to be set on malpractice judgements.
It is unfortunate that he has apparently gotten sick from being coughed on by a patient. Perhaps he, and all physicians, need to take measures -- such as habitually wearing masks as dentists do -- to minimize their exposures. We cannot overlook, though, that there is a disturbing lack of compliance by doctors and their co-workers with efforts to reduce infections that patients acquire in hospitals and doctors' offices. These infections kill thousands of people annually. Worse yet, because doctors have overprescribed antibiotics many of the infections are now resistant to treatment.
We are not convinced by the professional advertisement the doctor offers: "In spite of the fact that you are clearly ungrateful, your doctor will still take care of you to the best of his or her ability, and at great personal sacrifice." He only confirms the general impression that doctors circle the wagons, placing the wants of their profession over the needs of consumers. (Realistically, though, it is that way in every profession, but most are not cartels.) Doctors are not mice, they are individuals. In my own experience I've encountered some exemplary ones and others who were callous, dishonest scoundrels. Why does this osteopath not allow for the obvious variations of quality and character among doctors? Because doctors are trained to band together for the sake of the cartel. That is why the University of Kentucky medical center began requiring faculty physicians to sign a pledge to not make "disparaging remarks" about other doctors.
My family was close to a doctor named Richard Stevenson. Unlike virtually every doctor I've met since Richard died, he was completely unpretentious. His patients, treated first-come-first-served, often called him "Steve" rather than "Dr. Stevenson," and he was much-liked. He was the old-fashioned, all-purpose doc, delivering babies, doing general surgery, maintaining a general practice. His clients were both rich and poor and he treated them all with the same respect and care. I believe when I met him in the early 1970s he was charging less than $10 for an office visit, shot included when necessary. His fee increased with the cost of living, but always stayed modest compared to many other doctors in the same town. Yet he accumulated enough money to travel internationally, support a wife who enjoyed fashionable clothes and a kid who liked fancy audio systems, and eventually build a home in Ireland. When he retired in the 1980s, Richard expressed disgust with the newer generation of doctors, driven by what he perceived as status and greed. He was a bedrock Republican, so he could hardly be accused of class envy. He just thought that the humanity of doctoring had been sacrificed in the era of Medicare and lucrative group practices. I dare not imagine what he would think of managed care and doctors who refuse to own up to mistakes. He was no deity, nor was he a political idealogue. He just established a relationship with his patients that was equal and honest. He didn't lord over them and flex his authority as do most of today's doctors, as deficient in humanity as they are proficient in technology. By the way, he practiced in Lexington, Kentucky, home to the same UK medical center that has prohibited physicians from making "disparaging remarks" about each other. Cui bono?
AFTER SPENDING more time at the AiA site, the osteopath sent a second email in which he shows that his anger and frustration bested him. He asks, "Do people, in general, really believe that modern day medicine is treating homosexuality with lobotomy?" It isn't clear what he means by "modern day," but it is certainly a fact, as we say, that "the former 'treatment' of homosexuals with electroconvulsive therapy (shock treatment), insulin coma, and lobotomy" was accepted medical practice. Homosexuality was officially classified as a "mental illness" until the 1970s. Apparently the osteopath does not know of this history.
He is also unaware of the horrific treatments visited upon epileptics. "Do people just accept your preposterous concept of epileptic colonies?" he asks. But it was the prevailing medical wisdom into the middle of the 20th Century that epilepsy was evidence of pathological criminality. Many epileptics were isolated in institutions called "colonies," some of which were later converted to "hospitals" for the isolation of people considered "mentally ill." Thomas Szasz has described this abysmal history in his book, "Cruel Compassion," which we recommend to the doctor. A 1994 documentary focused on one institution, the Lynchburg Colony for the Epileptic and Feebleminded (in Virginia). At that place over 8,000 children and young teenagers were forcibly sterilized between 1927 and 1972. The American biologist who drafted the sterilization law, Dr. Harry Laughlin, was awarded an honorary doctorate in Germany in 1936 with Nazi propaganda minister Joseph Goebbels as the guest of honor.
In the present, when many lobby for American physicians to kill their patients, calling it "physician-assisted suicide," it is important to be aware of past misdeeds committed in the name of medicine and public hygiene. From the osteopath's comments we can conclude that his medical education did not cover these matters and he objects to their discussion.
As for his complaint that our "prose is littered with typos and grammatical errors," he is probably right. As director I do most of the website editing. In the years since I had a botched liver biopsy at Stanford Medical Center, with consequential adverse drug reactions, I have had a severe persistent headache. It makes it difficult to be as meticulous as I would like. Nobody involved with AiA is an attorney, and we do not "bash" doctors. The "patients' rights" movement is increasingly dominated by persons seeking revenge for real and imagined harms. Their recommendations, for more lawsuits, regulations, and criminal prosecutions, will only make things worse, and we disassociate ourselves from their intemperate efforts.
Nicolas S. Martin
Executive Director
American Iatrogenic Association
From: XXX@aol.com
Date: Tue, 30 Apr 2002 00:47:46 EDT
Subject: why?
To: aia@iatrogenic.org
What is your purpose in bashing doctors? What drives an organization like yours?
Doctors today face enough pressures without having to worry about people like you patently trying to make our lives even more difficult in an organized fashion.
What rewards are there for giving up one's life to care for the medical needs of others? Do you still believe that just because a person is a doctor that he or she is wealthy and therefore deserving of resentment? Well let me be the first to unburden you of that misconception. I graduated from medical school in 1997, owing just over $100,000 in student loans. I am now two years out of residency and the interest has outpaced my ability to pay it back. My loan balance is now over $120,000. I live a modest life without luxuries or extravagance. I have not been paid a dime in over two months due to medicare changes and holdups. I had to borrow money to pay my malpractice insurance this quarter. I have been threatened with a lawsuit twice in the past year (although as of yet, have not been served an actual summons). I work from 7 am everyday (seven days a week) until at least 9 PM every night. I have not had a vacation in over two years. My office overhead is approximately 90 percent of my gross income. By current standards, I would just qualify for middle class if it were not for the fact that my debts take up nearly everything I make. I have three children whom I barely know, and a wife who thinks I don't care about her anymore. No one in my family has health insurance yet I pay for it for my staff. I gave up eleven of the best years of my youth to become this doctor that I am. When I finished residency, many of my friends from college already had IRAs and equity in their homes. I had nothing but debt. I have to work endlessly to document my progress notes so that I can get paid. I also have to work equally as hard to document so that I don't get sued. I am constantly barraged day and night by patients who call me at all hours. Some of that is my fault because I am soft on my patients and I even make house calls.
I do all this and continue everyday because there are rewards in it for me, but they are not financial ones. I feel good when I can help another human being feel better, or if I can help them die without pain or indignity. I like to prevent diseases and feel a personal loss when I am unable to do that. I get paid very little if you look at the hours I spend. I am constantly having to relearn how to do my job to adapt to the changing reimbursement and documentation legislations, while striving to provide top notch care for my patients in the manner I would want my loved ones to be cared for. By the way, did you know that Medicare reduced physician reimbursement by 5.4% this year across the board? That is a big chunk. Those of us who were just squeaking by have yet to see if we can continue to do so. Malpractice insurance rates went up steeply again this year, and health insurance rates for our employees are becoming prohibitive. I am presently suffering from pneumonia which I caught from exposure to a patient who coughed in my face. I have a fever of 102 degrees, but I worked today wearing a mask to keep from passing the infection on to my other patients. I will work tomorrow as well because my patients need me and because I can't afford to miss a day's work. I am on call the next night and will spend the entire night admitting patients to the hospital and caring for the needs of those who are already there. The day after that, I will work all day just as if I had gotten a good night's sleep (which I haven't had in weeks).
I mention all this because I want you to know just who you are criticizing. If you derive satisfaction in kicking a man who is already down, then you are achieving glorious success.
The next time you are ill and under the care of a doctor, I would like you to consider what I have told you here without exaggeration. In spite of the fact that you are clearly ungrateful, your doctor will still take care of you to the best of his or her ability, and at great personal sacrifice. He gave up much of what will probably be a short life to become a doctor, and sacrifices his mental not to mention physical health to care for you. The world for doctors is a litigious minefield. Reimbursements are constantly going down while expenses are going up. How would you like to spend your life in the world I just described? Who would? But we have no other options. By the time we finish training, we are too deep in debt, too old, and untrained for anything else.
Just thought I'd share that with you.
From: XXX@aol.com
Date: Tue, 30 Apr 2002 00:59:25 EDT
Subject: forget it
To: aia@iatrogenic.org
After reading your homepage, I am sorry that I dignified your article with a response. You are clearly a charlatan, and I wasted my time trying to reason with you.
I am just curious though. Do people, in general, really believe that modern day medicine is treating homosexuality with lobotomy? Do people just accept your preposterous concept of epileptic colonies?
Your prose is littered with typos and grammatical errors. I hope the common man will consider the source when reading your propaganda. If you are an attorney, then you are an example of why your profession is no longer considered noble.
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