Sunday, April 7, 2013

Medicine: 1960s to now

By current standards, the lack of third-party coverage would be impermissible. But treating patients without insurance meant that I had to give my acute attention to the price of every medical intervention. The costs could have a direct and painful impact on a family's budget. So I had to know the prices for most of the medications I prescribed and of most of the tests I might order. I learned to play for time by waiting, when it was safe to, before ordering an X-ray or a test—and to substitute less-expensive medications for more costly ones wherever possible.

I developed pastimes that were diverting but would permit me to be available to patients 24-7, requiring coverage by a substitute only for a two-week vacation annually. Few physicians nowadays would undertake such an onerous schedule, and yet many of the inconveniences are offset by benefits. If you are caring for your own patients, you know them and their ailments and can manage a great deal over the telephone (or by email these days), with minimal cost to them and minimal intrusion into your own life. By contrast, covering for another physician almost invariably means inefficiency—additional time to learn the patients' relevant history, and often either a direct patient encounter or an outpatient facility visit, all of which greatly add to the cost.

Then, in the mid-1970s, things changed, and we became enlightened. Third parties, typically the insurance companies, were interpolated between the physician and the patient. Some of the consequences were unfortunate.

Hahahahaaaa!!! That is ME laughing at YOU, cruel world.
    -Jordan Rixon

I could not love thee, dear, so much,
Loved I not Honor more.

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