Doctors

 No obstetrician has ever been sued for performing a cesarean section too soon on a patient in labor.

                                                 Anonymous obstetrician making a labor management decision

 When in doubt, cut it out.

                                                  An old medical axiom.

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Sometimes the dark side overcomes what Lincoln called the better angels of our nature.

                                                  General Corman in Apocalypse Now speaking of the  

What and who are the better angels of our nature?  Lincoln was suggesting these were humaneness, compassion, goodwill, tolerance, and other good things

`                                                Ambassador Ronald D.. Palmer

Introduction

 The role of doctors both directly and indirectly contributes to the rising costs of medicine and must be examined.  While doctors receive about 20% of the health care budget, they very directly contribute to the majority of spending in other areas (or they used to until insurance companies recently butted in).  Writing about doctors is the most difficult task I have undertaken.  The task is more difficult because of my perspective as a practicing family physician.  I neither wish to be a medical apologist or a medical heretic.  It must be stated in advance that there are thousands of committed caring hard-working doctors across the country.  It must also be acknowledged that there is a shift among even well intended occurring in the direction of commercial and economic values, away from the professional and ethical orientations.  Whether by nature of the system, ignorance, seduction, or greed, it is occurring.  The shift is away from doctors being humanitarian scientists to being entrepreneurial scientists. 

 Looking at the motivation of physicians on a bell curve, it probably could be stated that perhaps 5% at one end of the curve are committed and are driven by a calling to serve people.  They were not influenced by money and perks.  On the other end of the curve probably 5% were bad apples from the start.  The 90% in the middle of the curve are the ones whom I believe have changed the most.

 For the most part they chose medical careers as a way to help people in a respectable profession and likely have a reasonable income.  I really don't believe that these people started out wanting to be millionaires.  Medicine was once a very enjoyable profession with shared goals of patient care, teamwork, teaching, learning and a goal of excellence.  I do not believe I am just speaking for myself when I consider my past experiences.  The very most enjoyable and stimulating years my practice were my first two in the public health service setting.  I worked in a clinic for migrant farm workers.  Everyone rolled up their sleeves, worked together, supported each other, and worked hard.  Money did not influence.  I know many physicians who say the same thing about their joy in professionalism at the time of military service, Indian health service, Peace Corps work, teaching, etc. Today the system environment has changed and I'm going to review various aspects of how we got here and where we must go.