Fri 4 Sep 2009
Are Doc.’s Technicians?
Posted by USA / RK Halley under Balkers
[7] Comments
With all the reform debate the insurance corps are being as quiet as mice. Oh they are all sending people to DC to talk with Senators and Represenatives. Each Corporation, even the third party administrator companies, are entering offices and speaking directly to our politicians. More at stake then mere health Ins. reform. Products/policies that are sold without SEC review. Those products may yet fall under banking oversite rules and regulation. In the future requiring lisenced brokers rather than agents slinging them out for public purchase. Just wanted you to know that behind the scenes the Insurance Mice are moving in the dark.
The vocal group with much umbridge are the practicing doctors of today. In the USA they have precarious history. They claim direct rite to the itellect of Rhode Scholar, paying huge educational costs which entitle them to practice in issues of life and death, but to manage their profits as a business entity. If we question their decisions or the effectivness of their treatments. some become irrate, while others from a newer scope allow such verbality by mere laypersons.
That we have allowed them to become arrogant and spoiled is maybe a notion of schooling or perhaps Mom & Dad should have just raised nicer children. Should you question them on a blog, or in a opinion piece expect to get an earful. I am accustomed to it. having been a nurse for many years. Being a patient of a certain age puts you in a position to see some of the myths, being ill places you in a vulnerable place outside of any geography you may have known.
I once identified Doc.’s as people with a head to toe definition of diseases. Able to weave a cause and treatment together. Today they are a much more disjointed group. Neither a God nor hero, doctors don’t much like joining the working world. When I describe them as talented technicians the sky falls.
The huge numbers of accessory staff are often completely ignored as doctors lay claim to low pay, long hours, bad conditions, over-priced education, and dealing with life & death decisions.
In truth the accessory staff does all those things too. In fact the doctor is brief in the encounters with such things, relying on the skilled professionals to lead them into decisions, implement the course of action, and to educate and explain out-comes.
Allow me a small rant as I say your kind hearted Doctor does not make your appointment with the specialist, does not call you with the result of a test, nor catch you as you go south after surgery. He or she does not call with orders as you enter the hospital, nor complete the majority of assessments that tell the medical model where to look for a problem. The doctor relies on staff, testing and patient complaint to do that.
Do we sympathize with this new technician? To some extent we do. And it is hard to define why. Like the master rope maker that is finding the craft becoming archaic, or the interchange of idea’s outside of pen to paper, the doctor is adrift. Squeezed between a discerning consumer and the reimbursements of Corporations. A doctor finds powers of awe diminished, and scope in question.
I am always reminded of the movie. ‘In the Heat of the Night.’ You feel something is slipping away, and that it might not be so bad to see it go.
The Doctor enters my hospital room and asks, “What should I call you?”
Oh, that all depends on what name you go by Doctor? For now I am using all my energy to just be a ‘patient.’
I’ll bet MD’s will be in a much better spot once the oppression of
insurers has been reduced by health reform. (Even with the weakened
bill, demanded by Republicans who wrecked our economy with their failed laissez-faire ideology).
I never saw MD’s as gods, but they get far more schooling than technicians of course. The big question is capacity I’d say. With the United States being shackled in a “market-based” insurance system by the presidents and lawmakers of the Reagan/Bush Error (that’s decades of grossly inadequate health coverage for Americans), if we now will enfranchise 50 million for proper medical care, it may indeed be only support staff who see them… ;^)
In the research side of the medical field, a PhD better educated to do research than an MD may still have a job title of “technician”. And in assembly line medicine, doctors often don’t have time to be more than technicians.
Ethically speaking, I believe the US medical community has totally dropped the ball on wars the US wages overseas. Those in the military have “materially aided” a government sponsored terror campaign, which has pretty much destroyed the public health infrastructure in Iraq, resulting in hundreds of thousands of deaths. The hell with “first do no harm”. I realize they are not the shooters, they are more like the getaway car drivers, but they are willingly part of the system. So in that ethical sense, they are more like technicians than doctors, despite their considerable expertise.
Are there enough MDs (and DOs, osteopathic doctors fully educated, tested, and licensed) if all in the US were covered? A simplified, single payer system would probably save enough physician time per patient that the average patient would get more time, not less, despite the increased numbers.
But would an ethical boycott of military service by all doctors, stop that army from fighting it’s war? If not, an MD could contend it would be happening whether he or she is there to patch up the injured or not, so
they then see the role they play as humanitarian. The issue can turn into one of those philosophical prisms, indeed… ;^)
I likewise believe that doctors under a reformed healthcare system, would actually have more time to be doctors. Even if the massive number of new customers does create a shortage of providers, it’s no reason to keep denying insurance under the current corrupted U.S. system. I believe you approach it with the commitment to do the right thing by your citizenry, i.e. cover them, and work the kinks out from there.
RoyG – An ethical boycott may very well stop the occupations of the invaders, sooner than if they did not act ethically, with fewer overall casualties. The US is not very tolerant of its own casualties (which is understandable), but pays little heed to the deaths of others. Without advanced medical care, US deaths would be far greater; as it stands now, as a fraction of the total deaths from the wars of all people, pretty much nobody from the US has died. While a US battle surgeon may treat anyone on his operating table equally, triage is done by the killers. Triage based on need would mean that only a small fraction of those treated by US medical staff would be from the US; the vast majority would be locals.
A lack of professional ethics, and a lack of patriotism (loyalty to country and countrymen, as opposed to loyalty to buddies and chain of command), are integral parts of the US military machine. Professional objections, from those committed to medicine, religions, law, and defense, could have forced honest debate about the morality, purpose, cost, and utilities of these wars. This did not happen, as Smedley Butler was correct about the military: they are gangbangers first, stooges for organized crime (corporations).
I personally oppose pre-emptive wars like Iraq and Vietnam, but find justification in offensive operations that went to stop things like Hitler, Milosevic’s genocide in Kosovo, and the Taliban that harbored gihadists whom perpetrated the 9/11 attacks. Even for those, I believe the use of force can be only a part of a larger equation on the diplomatic and economic fronts – that “winning the peace” part. (i.e., Marshall Plan)
But I really value perspectives such as you post rp, because it provides true counterpoint to rampant Wingnut propaganda in America. A view like that is one that never makes it onto major commercial media in the U.S. – fact of which exposes their right-wing bias and mega-corporate allegiances.
Which is why they do things like cheerlead rather than independently assess the Iraq invasion, and regurgitate over and over a handful of lunatics screaming “death panels”…
I believe people who choose the medical profession should be dedicated to their profession, and not to increasing their personal wealth.
Many doctors are dedicated people who care more about the health of their patients, rather than how much money they can earn through their chosen profession.
And these dedicated people are the ones that never get wealthy, but they contribute their services for the good of humanity, and deserve respect for themselves as well as for their chosen profession.
Where in the otherhand some people choose the medical profession to increase their social status, prestige, and as well as their financial wealth, because such profession is unlimited in the amount of wealth that can be obtained through it.
And I believe that this also brings into evidence the fact that a national free healthcare system is not convinient to those doctors who are money oriented, rather than being dedicated to their chosen profession and receiving less than what they are receiving at the present working for private health institutions whom I believe pay very well, and certainly more than what a national free health system would pay.
Sammy from Sicily
Have enjoyed the posts. I like to wait and read before jumping in. Sammy what you say I would like to ditto, but it is ideal’ in America. The research of Wennberg is now part of an NPR story. I would encourage a listen to all.
Dr.’s are hopping on the famed social-medicine researcher. Wennberg is now 75, and has to my knowledge never been involved with private Corp kick-backs. His work has long been acknowledged. A man named Elliott Fisher is Wennbergs successor.
The evolution of the medical model is not oft’ talked about. But imagine that at one point the Allopaths began to regulate schooling. Not a bad thing, the germ theory at last recognized by the Medico’s or by more than not.
Think of Ciderhouse rules in medicine prior to diagnosis driven criteria. The good ol’ Doc. would get the uterus out of women who became worn down with breeding and larger families. He, or some few She’, knew your family and the history. So finding a medical reason vs. religous belief existed in many poor families. Still some of the better Doc.’s drew support from the elite. A little retainer or investing in their hospital. It keep the best at the ready for the needs of the wealthy.
The disparity left race, and class at the mercy of many others. The dying, the poor, people of color became a new vehicle and had some modern worth. Virtual human test tubes to advance discovers.
I also reccomend a series on BBC. Dr. Finlays Case Book. The updated 80′s filming. A history piece as the National Health Plan is shaped, it is set in Scotland and it is spiced with many of the arguments we face today in health care reform. You can find it on Youtube.
After Ciderhouse, Americans went to hospitals that were regulated. (Kinda) But the doc.’s found by hopping on certain speciality operations they could generate dollars and do 2 or 3 simplistic types of corrections. Over and over… they became as good at it as Fords assembly line. Mayo’s made their bones on thyroid, or goiter removals.
Through the decades you could trace need and numbers. Thyroid pops, Tonsil removals, Appendectomies to todays joint replacements and cardiac stents. Nurses keeping mum in the work corridors, called this trending. Oh we could buy the sometimes logic in regional area’s or medico related arguments.
Pop out the appendix of kids on farms and ranches, to prevent death due to infection and proximitry to rapid treament. Most of the older nurses wondered, was it really a benefit to perform in anticipation?
Wennberg, is the man who brought us the CPT codes for billing. Because of his work a DSM was put together, and these massive books were added to every year, and then quarterly. Oh Doc’s hated them. They didn’t like the DRGroups that listed normal length of stay in hospitals either. They had been like Gods. Raising themselves through rank and class with their good brains. And in America, we admired that.
We perhaps, are at a tipping point now. Lots of smart patients walking the frontiers. Doc’s have hand-helds, but their patients have the internet. The playing field is being leveled. Around 40% of patients walk through the door with an idea of what ails them. And mostly they are on the money. The ones who don’t are more likely the parent of a child, or too sick or scared to care.
So here is a timeline for the student of Medical history to look at.
The war of Doc.’s Allopathics vs. homeopaths & others.
The rise of teaching Hopsitals in America sponsered by famous patrons.
The rise of Apartheid-medical experimentation.
The Federal Government social programs, later to become public health.
Please include a read of Tommy Douglas.
And Roy G. your should enjoy the new triage systems derived from the Viet Nam War Years.
We are getting closer to a vote on the health care bill. People are edgey and divided. But they have opinions, which is so much more involved than during the Clinton 90′s experience. Insurance Carriers, nor Medical lobbists have been able to strangle the conversation.
If you have any thoughts I sure welcome the reads. Let me know. I am reading!
Nurses are talking back in the work corridors!