Donald Eugene Knapp was born in Burlington, Iowa, without a silver spoon in his mouth. He crossed a river, as a child, with his family, like so many immigrants, seeking a better life. That’s how he came to live in Blandinsville, Illinois http://en.wikipedia.org/wiki/Blandinsville http://maps.google.com/maps?oi=map&q=Western,+IL
There, he met Averill, and they have been happily married for fifty five years. After a brief career in Naval Aviation, in P2V Neptunes, he went on to what is now Western Illinois University, in Macomb. His original plan was to become a veterinarian, but decided to shoot for the sky, and go on to medical school.
That’s how we met. At the University of Southern California in Los Angeles, near the Coliseum, in 1958, at adjacent cadavers! Anatomy for first year students. Through an accident of alphabetical proximity, Knapp and Lewin endured the process of transformation from wide eyed, awe-struck students to novice physicians. We learned from the same professors, played ping pong at midnight out back in the old classrooms, saw one teaching case after another and decided that we needed to get to a different place than Los Angles County Hospital, We visited Fresno County Hospital on the recommendation of Richard Gordinier, and with several other U.S.C. students, we applied for and were matched with FCH. Don went on to be a gastroenterologist and has spent his whole career, in Fresno, scoping out its citizens. One might say, he knows the population inside out. He’s now retired. We’ve stayed in touch, but never as close in proximity as those wonderful days of medical school and internship. My oldest son, John, the Republican, was born in Fresno, had his briss (ritual circumcision) in Don and Averill’s living room, and Don was made his Godfather.
When I seized little John and little Geoff, defying a court order, plunked them into my Porsche, and fled for a weekend visitation, I received shelter at the Knapps. Don is the kind of older brother and wise counselor that everyone should have.
So, on the way up to daughter Becky’s for Thanksgiving, we arranged to meet at the Harris Ranch Kitchen, about 60 miles from Fresno, on I-5 in Coalinga to reminisce and catch up.
The topic turned to the subject of this discourse. We both have come from working class backgrounds and the Midwest, although Blandinsville and Chicago are two very different places. Still, Don and I went into medicine for the very same reasons. The science was very interesting and we wanted to help people and do something that was worthwhile, something that we could be proud of. Medicine was a profession and big things were expected of those who chose to enter the profession. Doctors did good things and people respected them and no one ever questioned that saving lives, relieving suffering and providing compassion, were noble deeds that benefited mankind. The physicians who taught us inspired respect for their knowledge combined with their empathy and concern for the patients who passed through L.A. County. They were people, not diseases, and we were grateful for the opportunity to learn our profession in the company of these physicians. They did not teach us that medicine was a business, only that health care was an expected consequence of being a citizen of a great country in the 2oth century. The county hospital was a teaching institution in addition to providing care for indigent patients. Training for the doctors and nurses of the future happened within its walls. Medical schools were staffed with full time professors and voluntary clinical faculty who brought the medical students along the path to their lifetime careers, and did so with little concern for the possible remuneration. The focus was on the science, the illness, the therapy, the patient. There was a collegiality in this medical community. There was a profession, a calling, an unspoken commitment to values that characterized a profession that had evolved before the tools of science made diagnosis and treatment the expectation that it is today.
There were progressive and regressive forces at work, and we had no perspective as novitiates into this community. All we had were models, and we chose them, along with fields of particular interest, and we were carried along in the current of our profession, eventually settling into our own professional ruts.
We saw health care evolve, slowly, at first, but now, increasingly, from a profession with components of professionals, guided by the ethics of a profession, into what it is today, the health service industry. Wikipedia deals with the concept of a profession and includes this statement:
“It has also been suggested that some professionals feel an obligation to society, beyond their client relationship. Doctors may not merely sell their service if a procedure is medically inappropriate, however much the client may want it undertaken, architects may refuse to work on a project that would be detrimental to its surroundings, lawyers may refuse to take cases which are merely exploitative. The obligation to educate the client is often seen as a key part of the definition.” http://en.wikipedia.org/wiki/Profession#Common_qualities_of_professions
The advent of advertising, and “education,” in the form of advertisements, has opened the door to the medical entrepreneur, who may now be promoting services and procedures, modes of delivery, that target objectives other than those so well stated in 2001 by the American Medical Association:
Principles of medical ethics
0. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
0. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
0. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
0. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
0. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
0. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
0. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
0. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
0. A physician shall support access to medical care for all people.
Adopted by the AMA's House of Delegates June 17, 2001.
In the Los Angeles Times of Monday, November 21, 2006 there is a 12 page section, entitled, “Health.” There are articles on waltzing as a painless workout, good habits leading to long life, computer aided diagnosis and coaches for followup health care. Interesting, provocative articles designed to educate and inform, and amongst the articles, very advertisements, not necessarily designed to educate but definitely designed to inform, and to solicit business. The advertisements in the Health section include pharmacies with “new low prices,” “menopause and estradiol” by U.S.C., soliciting possible patients for a trial study that offers free examinations (paid for by whom, and with what level of expectation?), “stop back pain without surgery,” and then today’s iteration of the snake oil salesman with mesotherapy and thermage, the one hour face lift. Be reassured that Dr. Deirdre Habermehl, with offices conveniently located in Beverly Hills and Newport Beach, “was certified in Paris in Mesotherapy by the creator of the technique, by Doctor Jacques LeCoz.” And also be reassured that….”all procedures performed by Stanford University trained physician.” I have not checked whether Stanford University’s School of Medicine has reacted with similar apparent pride in this particular statement, but it might prove interesting. In the same advertisement is a photo of Leeza Gibbons just above the “Fall Special on Laser Hair Removal Package.” And the availability of the 1-Hour Face Lift! (As seen on Oprah).
So, what are more conventional physicians doing at a time when 46,000,000 Americans lack access to health care. Dr. Fett, of the Fett Eyelid Center, is “Correcting eyelids is what we do best.” The Betty Ford Center in Rancho Mirage Is a non-profit licensed addiction treatment center. Does it accept Medicaid? Ultimate nasal contouring, facial aesthetic concepts, Sculptra, the liquid face lift, vein removal – free consultation. And on the same page, home loan advice! Take out a mortgage and contour your nose. A lawyer advertises for victims of nursing home neglect.
And so it goes. Twenty first century America spending more than any other country on health care isn’t getting the results in longevity, maternal-child health, and many other markers of health care quality as many other industrialized nations. To quote from the webpage of the Physicians for a National Health Plan, “The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 46 million without health coverage and millions more inadequately covered.
This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment though a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.” http://www.pnhp.org/
We can lead the world in the availability of Botox injections, nasal recontouring, or breast implants, but can some of those physicians spend a little time thinking about where their profession has gone, and look at the days when becoming a physician was not a ticket to affluence alone, but an opportunity to join a profession dedicated to the nine principles of medical ethics, to the collegiality and satisfaction of knowing that mankind has benefited by the investment in education that results in a career in the medical profession.
There are many ways to improve the lot of American physicians but first they must decide whether they wish to be in a profession or switch to a business model. Hopefully, there is still some small core that cling to the model of medicine as a profession