Medicine: The Death of a Profession

We go to doctors because we want their expert medical judgment on what’s ailing us and how to fix it. In the Wall Street Journal, Zane F. Pollard, a pediatric ophthalmologist, writes about what’s routinely interfering with his ability to exercise his best judgment when it comes to treating his patients: government regulations. Pollard provides several examples of his experience with Medicaid, the government program that pays for the medical care of low-income Americans:

  • Medicaid requires that doctors obtain pre-approval for the surgical procedures they intend to perform. But this makes difficult any change in plans during surgery. As Pollard explains, while operating on a child with crossed eyes, “I discovered the need to change my plan to accommodate findings resulting from a previous surgery by another physician. Armed with new information, I chose to operate on different muscles from the ones noted on the pre-approved plan. The revised surgery was successful, and the patient obtained straight eyes.” But because Pollard had not gained approval for the surgery he actually performed, Medicaid paid him nothing for his efforts, despite his more than year-long challenge of this decision.
  • Medicaid pays for medications that are dispensed only in certain quantities. Pollard writes about a teen patient with glaucoma: “Medicaid regulations only allowed the pharmacy to fill a prescription for a one-month supply” of the necessary eye drop, but this particular eye drop was only available in one amount, which lasted two months. “The pharmacist asked me if I would change the prescription to order another Medicaid-approved medication that would satisfy the one-month-only supply policy. I refused because my patient’s ocular pressure was well controlled by the particular medicine I had requested. Her vision was preserved because of that drug’s effectiveness. Only after numerous contentious calls with the pharmacist and Medicaid was I able to obtain the prescription.”
  • Perhaps the most frightening instance Pollard describes is of a “14-month-old child with the symptoms of Horner’s Syndrome, a condition that can be caused by a neuroblastoma (a malignant tumor). I ordered a CT scan of the neck and chest, as these are the two most common sites where this tumor appears. Medicaid approved a CT scan of the chest only. I spent several hours on the telephone pressuring my state’s Medicaid officials before I received permission to have both the chest and neck scanned. The scan of the chest was negative, but the scan of the neck revealed a malignant tumor. A pediatric surgeon removed the tumor and the child is doing well.”

Note the choice Medicaid presents time and again to Dr. Pollard: in order to follow his own judgment, do what is best for his patients, and maintain his integrity, he has to spend his time fighting regulators every step of the way and often forgo payment for his services. As patients, is this a choice we want our doctors to have to make?

Medicaid is but one government program controlling medical care today. In “Medicine: The Death of a Profession,” Dr. Leonard Peikoff details regulation after regulation that presents doctors with similar situations to those of Dr. Pollard’s. Dr. Peikoff asks:

Would you like your case to be treated this way — by a doctor who takes into account your objective medical needs and the contradictory, unintelligible demands of ninety-nine different government agencies and lawyer squads? If you were a doctor, could you comply with all of it?

The result, as Dr. Peikoff points out, is: “A doctor either obeys the loudest authority; or he tries to sneak by unnoticed, bootlegging some good health care occasionally; or he gives up and quits the field.” Dr. Peikoff wrote this almost thirty years ago. Since then, government control of health care has drastically grown and the problems he describes have only gotten worse.

The thought of good medicine today having to be “snuck in,” “unnoticed” and “bootlegged,” should terrify us — and compel us to challenge the government’s increasing stranglehold over our medical care.