Saratoga News

Columns

Point of View

What's up, doc? It takes visits to six docs to find out

By Carl Heintze

I've got a friend who has been sick. The other day I counted up the number of doctors she's seen in the last two weeks. It came to a total of six.

There was the internist, the obstetrician, the neurologist, the orthopedist, the oncologist and the radiologist. (Well, she didn't really see the radiologist, but he looked at her X-rays, and I'm not counting the pathologist who checked out a couple of biopsies. Nor does this include the gastroenterologist who got the whole thing started in the first place with his examination.)

Coincidentally, unrelated to anything else, she also saw the dermatologist for what she thought might be a skin cancer. (Turned out it wasn't, but you can never be too safe, right?)

When I was a kid--which I admit was a long time ago--I lived in a town that boasted--or rather admitted--it had four doctors. It also had one not very good hospital. The doctors were all known as physicians and surgeons.

That was because they saw patients, and they also performed any surgery done in town. If the surgery was too complicated, they sent their patients off to San Francisco. They also all delivered babies and took care of the babies after they were born. And they all died young.

The doctors, that is, not the babies.

That was a long time ago, of course. There were no cardiac surgeons, no heart tranplants.

People talked about cancer in hushed tones as if cancer were something like leprosy. People with cancer just withered and died. About the only treatment was surgery.

Not long before I came to San Jose, Valley Medical Center (then known as the County Hospital) signed up its first resident. He was a resident in obstetrics and gynecology (babies were all delivered by men in those days), and he lived to see more than 3,000 children arrive safely in the world.

The age of specialization had begun. Soon there were residencies in neurology, dermatology, radiology and so on; not long after that sub-specialties began to appear.

Internal medicine practioners didn't just examine and prescribe drugs; they began to be endocrinologists and nephrologists and a lot of other things. Neurosurgeons began specializing in surgery on the nerves, and orthopedic surgeons began specializing in particular joints, the knee, the shoulder, the hip and so on.

A plethora of specialists arrived on the scene, and the old general practioners, those who operated, prescribed, counseled, made house calls and died young, disappeared.

The sort of specialty called general practice lingered for a brief while and was superseded by family practioners who had to do residencies just like everyone else. And like everyone else in the medical profession, they, too, could be board-certified.

(Board certification doesn't mean much to laypeople, but it does to doctors. Someone who is board-certified has after study passed a series of examinations in his or her own specialty that is supposed to ensure he or she knows what he or she is doing.)

All this specialization guaranteed that medical care got better, but paying for it hasn't.

My friend gets six or seven different bills, or rather her health insurance company does.

It's a wonder any doctor knows when or how much or how often they got paid. Medical economics, how medicine is paid for, has become fragmented, to say the least.

Fortunately for medicine, computers came along about the same time as specialty medicine became rampant. Otherwise we would still be paying bills incurred 10 or even 20 years ago.

There's no doubt the technology of medicine has improved. The four doctors who serviced the town in which I grew up would look with awe at the patients who are being cared for today and how they are being treated.

They would marvel at how long people are living and how many people are living longer. At the same time they would be nothing but bewildered by the proliferation of specialties, billing, the complicated paying back and forth of government and private insurance claims, the whole mess that the economics of American medicine finds itself in today.

And therein hangs the dilemma.

We'd like to have the care we get from all the refinements that technology and training in medicine has brought us, but we also would like it somehow simplified. We'd like to be able to go to the doctor, not to be handed around from physician to physician as if we are somehow not a person but a collection of unrelated disease states, to get not a dozen bills but one, and to have all this delivered with compassion and understanding.

And to have doctors who successfully make into retirement where they can enjoy the life their patients have been living all along.