Pundits abound when it comes to health care plans. They come from many different backgrounds: conservatives, liberals, academics, business people, doctors, politicians and more often all the time various combinations of these. But they all have one characteristic in common. They all want a different kind of health care for themselves and their families than they profess for everyone else.
I am acutely aware of this as I am in a position that demands that I find special appointments for them. A day virtually never passes when I don’t receive requests (often many in a single day) for me to either see these people myself or arrange for their special care elsewhere, including other parts of the county and the world. My own personal ethical code of conduct prevents me from mentioning their names or anything that could identify them. Suffice it to say that I have yet to see a single exception to this principle.
In academic and media articles, they proclaim that we are in a health care crisis; that health care is unsustainably expensive; that it is ridden with error and that there is no evidence that individual personalized care by an expert is any better than that provided by a system, such as the so-called “patient centered medical home.” They virtually all are certain that the system that has evolved over centuries of doctoring is now nothing but a quaint relic and is rapidly being replaced with a team approach with fewer specialists, more generalists and more non-physician health care providers. Yet, when they have a personal medical problem, in a loved one or even an acquaintance or important person whom they wish to impress, they seem to locate my antique email address.
If care by someone like me (an old specialist in an academic medical center) is not preferable to the team-based care that they profess, why do they insist (even demand depending on their level of political connections) that I see them personally, often urgently, even for mundane medical problems, such as longstanding headache, chronic dizziness and mundane back pain?
The reason seems self-evident.
Despite what they say, they believe that care by an expert is superior, and that is what they want for themselves, their families and their powerful friends. I will not list their names, but it would be a Who’s Who is medical punditry. Also included would be local and national politicians, titans of industry and anyone else who wants the best for themselves while advocating a different level for everyone else.
Some years ago, I was acting as a visiting professor in Canada. I was discussing a patient with a disorder that I thought required a rapid, though not urgent, intervention. I was discussing the optimal timing of the intervention, when a chuckle arose in the audience. I inquired about why people seemed so amused and they told me that considerations of that type did not apply to this particular patient because he was going to be “Buffaloed.”
What could that mean, I inquired?
It means that this patient had private insurance and would go to Buffalo for the procedure rather than wait in the queue in the regular Canadian health care system. The reason the Canadian health care system works as well as it does (and that is not by any means optimal) is because 90% of the population is within driving distance of the United States where the privately insured can be Seattled, Minneapolised, Mayoed, Detroited, Chicagoed, Clevelanded and Buffaloed, thus relieving the pressure by the rich and influential to change a system which works well enough for the other people but not for them, especially when they are worried or in pain.
In the United States, there is no analogous safety valve so the influential simply demand a different level of care and receive it. This includes all the authors of the major books, articles and policies that have been written to repair our allegedly hopelessly expensive and error prone system. The array of suggestions is practically incomprehensible partly because there is a secret hypocrisy. Will the pundit actually use their proposed system themselves?
So my suggestion is quite simple.
Whenever anyone writes about the rehabilitation of our health care system, they should be required to publish their own health care history, so the public can see where these experts obtain their own medical care. To protect their privacy, specific diseases need not be declared; just the method by which the pundit handled his or her own medical problems. This would be analogous to requiring that politicians reveal their income tax records or that academic doctors report any real or perceived conflict of interest when publishing a paper. Articles, proposals and laws written by anyone who is unwilling to publish his or her own health care history would simply not be considered or published. If just the leading newspapers and opinion magazines would agree to this system the degree of credibility of proposals for changes in our health care system would be dramatically improved.
Our health care system is not perfect, but any changes should be just as good for the gander as for the geese.
For the record, I have an internist of my own choosing (an antique doctor in my own hospital), who directs my medical care as he sees fit. As he is very skilled and experienced, unnecessary expensive testing and drugs are generally minimized, depending instead on his judgment, history taking and physical examination skills.
There you have it; my disclosure. For those who are tempted to respond to this piece, let’s see yours.
Martin Samuels is a practicing neurologist and founder of two Harvard-affiliated neurology departments. He holds a membership in the American Neurological Association, a fellowship in the American Academy of Neurology and a mastership in the American College of Physicians.