Strong forces aligned against medicine

“Doctors for America,” which appeared in the Winter 2010 issue of Yale Medicine, emphasized the need for physicians to be engaged in health reform.

Never have the forces aligned against medicine been so numerous and so strong. The destiny of the profession has been jerked out of physicians’ hands by insurance and drug companies. Their profit-based goals undermine medicine’s humanism. Thus Doctors for America’s efforts to recruit physicians to protect the heart and soul of medicine are as necessary as they are admirable.

Two issues resonated strongly with me: increasing the reimbursements for primary care physicians and eliminating the defects of the malpractice system.

As is widely known, most students are turned off by primary care. But merely paying these physicians more for their services is not the whole answer. Their training should be more in touch with what the real world requires of them. In my pre-med years I knew several students who would have made excellent general practitioners but who, because of average grades in organic chemistry or biochemistry, lost out on their dreams of becoming physicians.

Making the basic science courses less intensive for those interested in primary care would attract more into the specialty. This sounds heretical, but most primary care doctors have no need for the organic chemistry and physics and biochemistry that they endured as rites of passage.

The biggest problem with the malpractice system is that it allows unpreventable bad outcomes to be misconstrued as malpractice. Because malpractice suits can seriously harm physicians’ reputations and livelihoods, many doctors order tests and consultations that are not necessary specifically to ward them off. Not only does this raise the cost of health care immensely but it exposes patients to risky procedures and medications.

One thing is certain: Without strong physician engagement, the destiny of the medical profession will remain in the hands of those whose methods and goals undermine the humanitarian impulses that attracted most doctors to medicine in the first place.

Edward J. Volpintesta, M.D.
Bethel, Conn.