The Practice Of Medicine and The Color of Money

By Abraham Verghese

So seriously, does anyone believe that we doctors can own a hospital (or sleep center if you are a sleep specialist, or imaging center, or outpatient surgery center, or chemo center) and be totally objective about referring patients there?

We doctors aren't coming out pretty in the health care debate. A few days ago in a Wall Street Journal online piece, I asked, Who Speaks for Medicine?  With physician groups lobbying for their self interests, who, I asked, represents medicine, by which I mean the art of medicine, the ideals that we love to impart to our students at graduation and white coat ceremonies?

Well today's New York Times has two stories that show us at our conflicted best:

  • First, a report of a doctor-owned hospital in McAllen, called, appropriately, Doctors Hospital, which is flexing its muscles in Congress in the health care debate. The hospital (or rather its doctor-owners) has a big voice largely because of the substantial donations it or its proxy made to politicians. What does Doctors Hospital want? It wants to be sheltered from legislation that affects its income--and so far it has worked. (This is the same hospital that was written about beautifully in the New Yorker by Atul Gawande--a hospital that provides great care for patients but consistently does more tests and has more consultants involved per patient than comparable hospitals elsewhere.)
  • Another report also in today's New York Times describes dozens who were arrested in a health care fraud sweep.  Alas, doctors were among those arrested in this scheme. It  involved selling 'arthritis kits' to patients that were worthless; another scheme involved billing Medicare for Ensure and other liquid supplements that were never given to patients or billed to dead patients. The estimate is that BILLIONS of dollars are lost in this fashion, by bilking Medicare.

I am more and more convinced that the President does not need to look for new taxes to fund his health care plans. The savings in Medicare from eliminating fraud would be huge; add to that savings from restructuring payments and it would be even more substantial.

Speaking of payments, the AMA and other organizations are fighting the idea of an independent commission that would set fees and reimbursement schedules. God knows, such a commission might make it pay to be doing for a patient rather be doing to a patient. Alas, the money is in doing to; the AMA is against that changing.

As a confession, in those days when we all had close and cozy relationships with pharmaceutical companies, I took honoraria, spoke at conferences in beautiful resorts and had many free lunches. Of course I told myself, that all my professors and colleagues were doing it so it had to be OK; and I actually thought I could certainly separate the free lunch from any tendency on my part to prescribe a drug produced by that company. Looking back that was naive.

What brought about change was public scrutiny. Universities became hyper aware and now of course we all treat pharma contact with great caution. My point is, until public sentiment, embarrassment and finally our good conscience kick in to tell us something is wrong, we will keep dipping into that trough.

I think legislation needs to put an end to doctors profiting on businesses to which they can funnel patients--that is business not medicine. If you try to call it medicine then it is corruption. Without legislation, it will keep happening.

This article available online at:

http://www.theatlantic.com/technology/archive/2009/07/the-practice-of-medicine-and-the-color-of-money/22451/