The humor behind health care reform

I was buried in a sea of charts when a colleague joined me in the physicians' lounge. We joked about our frustrations with paperwork and patients, while somberly agreeing that medicine's in a bad way and physicians are more and more dissatisfied.

At the same time, we recognized that many of our problems are self-induced, stemming from doctors' tendency to ignore fundamental truths. So I set out to compile a list of what we need to remember-truths that often go unnoticed while physicians utter empty words about professionalism, duty, and healing.

The Protestant Reformation began with Martin Luther's theses. I'm not Luther, and my "undeniable truths" may not be nailed to a church door. But they could be the stirrings of a healthcare reformation.

Medical care isn't free, and it won't ever be, this side of heaven. When people talk about free care, they really mean "free to the people getting it," or "it seems free because the premiums get taken out before you get your paycheck." Medical care can't be free because someone (usually a doctor) has to be paid something (money) to keep providing it. A hearty thanks is nice, but it doesn't pay the kids' college tuition.

Some patients just don't pay, even after they get a check from their insurance company. But they keep coming back anyway. Then there are patients who come in with a toothache and say, "I came to you because I don't have any money for a dentist."

"Thanks for thinking of me," I think, as I tackle their periodontic infection anyway.

Insurance destroyed medicine. A few stitches shouldn't cost $500 in any emergency department. Fees are greatly inflated, too, for many surgeries and procedures. But because some patients don't pay (and insurance companies deny some claims), other patients get stuck paying too much. I'm a little embarrassed by the amount on my bill when I send it to patients who actually intend to pay. If everyone paid a little-and I mean everyone-costs would come down for all.

Policymakers see too few patients. It's easy to make decisions about the docs in the trenches when you're eating a catered lunch in a quiet boardroom. We have too many rules, slowing down care and making both patients and physicians unhappy and frustrated. The rulemaking has to stop before we collapse under the weight of "good ideas."

Patients are not customers. Doctors wouldn't have battled yellow fever and smallpox for "clients" or "customers." Patients and physicians have a unique professional relationship, owing to the Hippocratic Oath. Medicine is not about pleasing the customer; it's about healing the patient.

Patients need the truth from us. There will come a time when you have to tell a patient: "You don't have any physical disease, you're depressed, and I'm not giving you any more narcotics, sedatives, or anticonvulsants." Or, "You don't need to be on disability because you don't have a medical problem." Or even, "You wouldn't need another bypass surgery if you lost 200 pounds and quit smoking."