Crisis, what crisis?

Before one can do something for a living he or she must typically have an aptitude for it, an interest in it, and a period of training under supervision. Upon completion of that training there is examination and finally certification. Variable amounts of cleverness, intelligence, focus, endurance, and passion are requisites to arrive at that point in one's career. There will have been payment of some sort--cash as well as the labor of the entered apprentice or student/intern/resident. No difference really between plumbing and medicine, at least as regards the generalities of preparing for a lifetime of laboring in the craft.

The body of knowledge is undoubtedly larger for the doctor than for the tradesman and so the flux of knowledge, or knowledge throughput in the course of the study years, is greater for the student doctor. For that reason the student of medicine must be a quick study. Even when all the years of study have been successfully completed the newly minted doctor knows but a small fraction of what is needed to be good at medicine. I do not know if this is as true of tradesmen but I would think so. (The late, great Trade Unionist George Meaney said that anyone who did not respect a plumber had probably never paid a plumber's bill. Such presence is acquired after years in the craft.) But the explosion of knowledge in medicine is orders of magnitude larger than that which is continually bombarding those in other professions or crafts.

Besides knowledge there are technique and style to be mastered, and wisdom to be acquired. If the doctor is going to practice medicine, this is termed clinical wisdom. Judgement is another quality of importance. It is partly learned and partly intrinsic. Nobility of character, kindness, maturity, generosity, a sense of purpose, even a sense of humor all round out the ideal doctor. Cultural sensitivity is ever more relevant in our American society. This goes beyond competency in the English language and is more true in some specialties than others. (Compare the relative importance of the doctor's mother culture in the case of a child psychiatrist versus that of a pathologist.) Honesty should be a virtue held in high esteem by those in all crafts and professions. Hopefully the doctor did not get into medical school by cheating. That would not augur well for an honest and decent life in the profession.

Persons who have had experience with a good doctor likely have experienced poor ones, too. Medical regulatory agencies manage to exclude doctors who are egregiously incompetent practitioners. But they do not distinguish between the good doctor and the poor doctor. As long as the doctor meets minimal standards of care, is current in continuing medical education, has passed all appropriate examinations, and has a degree in medicine from any medical school in the USA that is approved or from any medical school outside the USA (and the regulatory agencies of the states do not hold these schools to any proper standards for political reasons) he or she is allowed to practice medicine in the state. Each state is different and may or may not reciprocate with other states. Since licensure certifies basic competency as measured by written and oral examination but Medicine is both an art and a science the testing ends up as a measure mostly of skills and ability in science. Patients, though, sense the doctor's art more than his or her science. In this way success in the practice of medicine demands accomplishment in both the art and the science of medicine--at least success in the free enterprise sort of health care we have in our country today.

Socialized medical systems as found in some European countries and the government run systems that we have here in our country (Veterans Hospitals and Clinics, Bureau of Indian Affairs Clinics, Military Hospitals, Bureau of Prisons, and so forth) assign doctors to patients with little or no choice on anyone's part. Although this is no reason to expect fewer good doctors and more poor ones, it does seem to be the experience of many patients that the experience was different in the government run medical clinics and hospitals. And it was not on account of the hospitals' facilities, equipment, or staff. Patients rate the doctor-patient relationship different and not as satisfactory in the federal medical programs. Hearsay, not scientific polling, but worth doing some further investigation of a scientific nature. A lot is at stake here.

At a minimum the President's talk of crisis and doomsday predictions by experts of all sorts are surely discouraging the best and brightest of America's students from pursuing a career in medicine. The arduous training, the expense of protracted years of study, the stress on the individual and his or her family, the many factors predicting for success or failure all militate against selecting Medicine. The President's diagnosis of terminal illness in our American health care system and the politicians' dithering will also discourage any and all doctors presently on the job. This will leave us with a discouraged senior corps and a barely able junior corps of doctors when we need everyone in peak form. Many, many advances are coming down the research pipeline. More and better life for our citizens is what is at stake. These advances have been decades in development. And most of them will require a high level of technical knowledge and skill on the part of the doctor and the doctor's team. (Take the example of robotic prostate surgery or intensity modulated radiation therapy for prostate cancer cure. Both require a higher not a lower level of physician ability.)

There is no crisis in health care. That much is obvious. There are parties on all sides eager to carve up the pie of health care reimbursement. And there is a lot to be gained by the Social Democrats should all health care in this country be government run. The voting preference of government workers is strongly Democrat so moving one sixth of the work force of the country into the federal sphere should guarantee Democratic domination of the legislature, executive branch, and eventually the judiciary from the highest offices down. This appears to be the rationale behind the push to federalize the health care system. It certainly is not a mission on behalf of politicians to alleviate suffering or improve efficiency or cut costs. The federal government epitomizes frustration, inefficiency, and waste. But an election map painted in democrat blue coast to coast could be the goal. Color this crisis blue.