Sunday, August 02, 2009

An Outsider’s Take on American Medicine

Jonathan Kaplan’s The Dressing Station was published in 2001, but I am only reading it now. Much of the book is about battlefield medicine, but one part concerns his coming from Britain to America in the late 1980s. Born in South Africa, he attended medical school there, then went to Britain rather than be drafted into the military. With research budgets cut under Thatcher, he came to America to be able to pursue his medical career.

After his dreary British experience during a period of budget cutbacks, he greatly enjoyed the cheerful commercialism and general prosperity of American medicine. He promptly found a research project to work on that would enable him to write a Master’s thesis, and the work was fun and went swimmingly.

Nonetheless, Dr. Kaplan was quite disconcerted by some of the differences between British and American medicine. Working on another study, he reviewed hemorrhoid surgery results. He was startled to realize how much more surgery was done for minor piles in the U.S. than in Britain, though results were unimpressive – then “I found the payment invoices in each patient’s folder. These were met by the health insurers, who paid out a lot more for an operation than injections. . . . The logic of a for-profit system appeared to lead to expensive solutions and spiraling costs.”

He was also startled by anecdotal reports of how the stock market crash of 1987 led one surgeon to actually shed tears mid-surgery when he heard the news. As well, the serious, money-oriented medical students surprised him, as he was used to quite a number of more arty, intellectual types among medical students in other countries.

Still, he was thrilled about his promising research results on a heated balloon angioplasty device. Later, he was disillusioned to hear that after the device received FDA approval, the main competitor, a laser manufacturer, bought out the idea and shelved it to keep it off the market.

I thought his observations fit well with Dr. Poses’ concern about insidious corruption in medicine and too many physicians who don’t feel the expected fiduciary responsibility to patient welfare. As well, it makes Maggie Mahar’s term of “money-driven medicine” seem – well – on the money.


Doc99 said...

And the NHS isn't money driven?

Anonymous said...

I agree with the general gist of the article. The comments at the end do concern me somewhat. I agree with looking out for the patient's best interest in all areas, including fiduciary stewardship. What has been lost in the academic discussion is how badly the patient population has let down their side of the "doctor-patient relationship" in terms of their fiduciary duty by participating in insurance plans that continue to harry the very provision of care that physicians are trying to facilitate.