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Doctors on Healthcare Reform

November/December 2009, Vol 2, No 7 - Perspectives
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Doctors from across the country were invited to the White House on October 5, but the President did most of the talking. Medical professionals are being ignored or vilified more often than consulted in the current healthcare reform debate. To broaden the discussion, the Committee to Reduce Infection Deaths invited 16 highly regarded physicians to convene at the Grand Hyatt in New York City on October 19 to reflect on the current legislative proposals. Here's what they had to say on four key issues.

Government-Imposed Treatment Guidelines
Dr Jeffrey Borer, Cardiologist, named to Castle Connolly's America's Top Doctors: "What's the impact of guidelines on the doctor–patient relationship? Guidelines step in between the doctor and the patient. If it's necessary to respond to guidelines rather than what you see, feel and hear when you're evaluating a person, then perhaps you're going to do something that isn't really the right thing. There really isn't an average patient. Every person that you see with a medical problem has some unusual or unique characteristic and this often has to be considered in dealing with the problem."

Dr David Fields, Obstetrician and Gynecologist, Lenox Hill Hospital, New York: "They tend to forbid better-than-average medical care; guidelines are always average medical care...they tend to cramp the physician who can do better than average."

Dr Borer: "One of the more common problems that people have as they get older is a disease called aortic stenosis...[W]e can relieve that aortic stenosis with an operation with really very acceptable safety, low mortality rates...If that 85 year old cannot walk down the street because he or she is too breathless to do so...or feels lightheaded or could faint and break a hip...then there is really a very good justification for offering the therapy."

Dr Richard Amerling, Nephrologist, Beth Israel Medical Center, New York: "The example that you give of valve surgery in an 85 year old is just not going to happen under [White House Healthcare Adviser] Ezekiel Emanuel. He's going to just say that that's a nonstarter. That person has outlived their useful years, no matter how long they could live beyond that."

Dr Borer: "What we're hearing from the President's medical advisers is that what we have is good enough and we really shouldn't be wanting or expecting any more."

Dr Seymour Cohen, Oncologist, named to America's Top Doctors: "When we went to medical school, people used to die at age 66, 67, and 68. Medicare paid for two or three years. Social Security paid for two or three years. We're the bad guys. We're responsible for keeping people alive to 85. So we're now going to try to change healthcare because people are living too long. It just doesn't make very good sense to me."

Shifting Resources from Specialty to Primary Care
Dr Cohen: "Let's talk about specialization for a moment...We don't go to our general attorney when we have a patent problem, but they're telling us to do this now in medicine. We have different types of engineers, even journalists. There's a financial writer, there's a sportswriter...Now in healthcare we're telling everybody, 'You just go to the guy who's your general doc. He's going to know everything and maybe we'll find a specialist for you if the panel decides maybe you're sick enough to need a specialist.' It really doesn't make sense at all."

Dr Jeffrey Moses, Interventional Cardiologist, named to America's Top Doctors: "If you have heart failure or heart attack or coronaries in general in the hospital you need to be treated by a cardiologist. Study after study shows that...when you have an illness and you want to have an accurate diagnosis and the most up-to-date and accurate treatment, you want a specialist."

Patient Privacy
Dr Samuel Guillory, Ophthalmologist, Refractive and Orbital Surgery, named to Castle Connolly's New York's Top Doctors: "We're being asked by the executive break the code with patients and deliver all their records into electronic medical records."

Cost-Cutting Methods
Dr Fields: "Government is in the process of duplicating everything that managed care did for the last 15 years that was reviled by everybody and which we fought very hard to overcome. The courts finally said, 'You can't have withholds. You can't pay people to deny care. You can't have gag rules.' The government is in the process of doing all that. Massachusetts is about to establish capitation [a fixed payment remitted at regular intervals to a medical provider] as the rule of the state. Capitation was the worst thing that ever happened to medical care."

Dr Joel Kassimir, Dermatologist, Mt. Sinai Hospital, New York: "We're now being told by physicians advising the president that we take the Hippocratic Oath too seriously."

Dr Tracy Pfeifer, Plastic Surgeon, President, New York Regional Society of Plastic Surgeons: "When physicians graduate from medical school we take an oath, the Hippocratic Oath, to do no harm to our patients. It's a very important philosophy to us and we uphold it and hold it very dear to our hearts. Plato, another philosopher, used to say things like, 'Those with a poor physical constitution should be allowed to die. The weak and the ill-constituted shall perish.'

These government programs that are being proposed I think are very scary in the sense that physicians could be induced to violate the Hippocratic Oath. There's a limit to how much of a financial penalty each individual practitioner is going to be able to bear...If the patient is sitting in the examination room with us and they're wondering, 'Is the doctor not ordering a test for me because he's going to get penalized if he does it?' This is a major, major problem for patients and physicians alike."

Ms McCaughey is chairman of the Committee to Reduce Infection Deaths and a former Lt Governor of New York State. For a complete transcript of the physicians' meetings, visit Reprinted with permission. Originally printed in Opinion Journal. The Wall Street Journal. November 6, 2009.

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