Spechwriting: Changing Environment of Medicine Speech
Given by ACP's President, January 2001
There is a new sound in America. And it’s one I don’t like to hear. It’s the sound of doors shutting in front of patients. And doors shutting behind physicians who are leaving the practice of medicine.
The health care environment and the way medicine in America is practiced are undergoing major changes. We have underinsured people. Overinsured people. People without any insurance at all. Some hospitals are posting record profits, while others are declaring bankruptcy and turning off their lights. HMOs are increasing access to care, or denying it in record numbers, depending upon whom you talk to. Optimistic young doctors are graduating from medical schools, while experienced physicians are leaving the practice of medicine altogether to pursue other careers.
From politicians we hear about prescription drug coverage for seniors, and about health coverage for children. We are the world’s wealthiest country, and have the world’s most respected medical system. People come from around the globe to seek medical care at our facilities, and yet many Americans can’t afford the most rudimentary medical care.
A recent study by my medical society, the American College of Physicians-American Society of Internal Medicine, showed that over 40 million Americans lack basic health insurance. People without health insurance lead significantly sicker lives and tend to die at a younger age. And, contrary to public perception, these are people who have jobs. They aren’t unemployed, homeless, or on the fringes of society. They are people that you and I interact with every day. That we talk to in church, at the supermarket, or in the street.
Remember when health care was something only your grandparents and their friends talked about? Now we see it everywhere. Local TV stations have "medical reporters" who cover nothing but health issues. The Internet abounds with health information. Pharmaceutical companies advertise prescription drugs on TV during football games and sitcoms. For better or worse, medical professionals are no longer the sole gatekeepers of medical information.
But many of the changes are for the better. You’re probably pretty typical of the population at large, which believes that good health care is very important – no, a right – of every American. You’re better educated today than generations past, and you are rightfully demanding a voice about the type and quality of care you receive. You are more likely to see your physician for minor problems, hoping to nip in the bud any potential problem. It probably comes as no surprise to learn that annual consultations with physicians have increased by more than 40 percent since 1970. The average life expectancy has also improved markedly over the past century, helping to redefine what middle age is.
Simply put, we’re living longer, safer, and more productive lives.
And, a lot of this has been thanks to amazing advances in medicine in the past century. Groundbreaking therapeutic treatments such as antibiotics, insulin, vaccines and drugs to treat mental illness have extended lifespans and improved the quality of life for millions of people in the United States and around the world. Tests such as MRIs and CAT scans allow us to peer inside a person’s body without having to use a scalpel. Computers and microsurgery have fostered unrivaled advances in surgical techniques.
Diseases like polio that once ravaged entire populations have been virtually eradicated through aggressive vaccination programs. We’ve seen a significant reduction in deaths from heart disease – our Number One killer – achieved through the treatment of high blood pressure, the lowering of cholesterol, the ability to open clogged arteries, and even the replacement of a diseased heart with a healthy one.
There have also been some major advances in the war against the Number Two killer – cancer – thanks to early diagnosis through mammograms and Pap smears, recognition of occupational risks, the role of smoking and improper diet, and treatment with medicines, surgery, and radiation.
This "golden age" of medicine has ushered in a new concept in medical care as we stand at the beginning of the 21st Century.
You can probably remember when a doctor used to regularly tote his black bag into a patient’s home for a checkup or bedside visit. It’s hard to believe that just about everything that was needed for the practice of medicine could be stashed in that little bag. A reflex hammer. A stethoscope. A thermometer. The tools of medicine were pretty basic in the not-so-distant past. Now, even if a doctor were able to make a house call (let’s not even talk about the HMO paying for it), he or she would have to lug around a multitude of high-tech instruments.
Not so long ago a doctor merely had to hang out a sign after medical school and the sick people of the community would come in for care. A doctor was a doctor. He was usually a man, and a white one at that. He would deliver babies, care for teenagers and adults, and tend to folks on their deathbed. In movies and on television, doctors were portrayed as kindly old gents who took care of everyone, and any hour of the day. Remember Marcus Welby, M.D.?
But over the past ten or twenty years medical care has undergone a radical change. Small corner-store doctor’s offices and community hospitals have been consolidated into groups that go by many acronyms: HMOs, PPOs, IPOs, and MCOs. Consolidation promised to improve service, making it easier for patients to get care and see specialists when needed. It also worked to cut costs by eliminating inefficiency, waste, duplication, and expensive delays created by not knowing which specialist to consult.
The results have been mixed. What were once spiraling costs have been brought a bit more under control. Patients have started to see their primary care physician more often, and now view their doctor as a sort of health care "coach," able to help navigate the often-confusing world of medicine. But we’ve all heard the horror stories, too. Coverage being denied. Waiting weeks to see a doctor. Shortened medical consultations.
Not only has the practice of medicine changed, but so have our nation’s doctors. More and more women are entering the field. This year, for example, nearly half of all incoming medical school students were women. African-American, Asian, and Latino physicians are providing care to millions of Americans. Whether primary care physicians or subspecialists, these doctors are helping medicine more accurately mirror the faces of those who seek treatment.
With all the changes that have been wrought over the past years, physicians have had to develop many new skills. Sure, we’ve always had to keep up with the latest treatments and scientific literature. But now we must be experts not only in diseases, but in the arcane coding systems developed by government and insurance policy-makers. We have to work with insurers to get prescriptions and treatments approved for our patients. We’re getting MBAs on top of our M.D. degrees just so we can run our practices more efficiently. And, we’re seeing our liability insurance premiums skyrocket, with physicians in some parts of the country paying over one hundred thousand dollars per year for coverage. Young physicians beginning practice may see over 50 percent of their annual pay eaten up by student loan payments and insurance costs.
Despite all these challenges, I’m still eager to go to work each day. Why? Because the premise of medicine remains the same: I get to help people. I develop relationships with my patients, and I look forward to seeing them and catching up with their lives. I have at my disposal more therapies and treatments than at any time in history. Illnesses that once had no solution can now be treated with a pill once a day.
Helping patients is the cornerstone of medicine. That’s why I’m proud to serve as the president of the American College of Physicians-American Society of Internal Medicine, representing 115,000 doctors of internal medicine. As internists, or doctors for adults, we’re actively involved with patient advocacy, lobbying Congress and governmental agencies for increased protections for patients. We’ve put together patient education materials, and have invested millions of dollars in advertisements to help Americans understand illnesses like heart disease and depression. Over the past year I’ve had the privilege to bring the problem of America’s uninsured before senators, representatives, and other policy makers.
There is a lot of health information floating around out there. Not all of it is good. Organized medicine is making efforts to have patient education be a priority now and in the future. But you can help, too. Don’t trust everything you see on TV or read on a Web site. Take care of your bodies now, so that you don’t have to worry about them as much in the future. And, most importantly, develop a relationship with a doctor you feel comfortable with. An internal medicine physician or other primary care physician can help guide you through the increasingly complex world of medical care.
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© 2001 American College of Physicians