Over the past fifty years, medical care has changed rapidly-and not always for the better. Technological advances and alterations in clinical service delivery have challenged physicians to remember to keep the best interest of patients in sharp focus. The Hippocratic Oath commits physicians to "do no harm" but the realities of the contemporary business world have forced the erosion of some ethical priorities. Pressure to satisfy profit-driven business models and insurance industry guidelines have put physicians in the untenable position in which patient care becomes more of a commodity than a priority. As a working physician in today's market, author J. William Evans, MD, explores these alarming trends through examples of how the "polluted oaths" have subtly distorted medical care as a whole. Dr. Evans investigates how the influence of the insurance industry has conditioned both patients and providers alike to accept inferior care as a standard. He shares the frustration of his patients, who are repeatedly denied the care they need. The entire industry needs immediate reform, he feels, and the citizens of the United States deserve access to proper medical care. In Hippocrates Weeps, Dr. Evans shares his thoughts on the current state of medicine as well as his roadmap toward better, safer, and healthier health care for all. What is required, he explains within, is the commitment to make change happen while allowing physicians to be true to the challenge set forth by Hippocrates: "Cure sometimes, treat often, comfort always"

Hippocrates Weeps

An Indictment of Changes for the American Health-Care SystemBy J. WILLIAM EVANS

iUniverse, Inc.

Copyright © 2012 J. William Evans, MD
All right reserved.
ISBN: 978-1-4697-7700-9

Contents

Preface................................................................xiMy Family's Influences.................................................1Medical School Training................................................7The Medical Oaths......................................................14The Polluted Oaths: The Profession's Shame.............................19My Internship and Residency............................................23My Mentors.............................................................28Personalities and Medical Training.....................................35My Military Service and Early Practice.................................38Corporate Medicine.....................................................47Insurance's Invasion into the Practice of Medicine.....................64Medicine's Contribution to the Mess....................................67Managed Competition....................................................75My Personal Experiences with HMO Intrusion.............................85My Professional Experiences with HMO Intrusion.........................94Effects of Changes on Health-Care Professionals........................103Problems in Caring for the Medically Indigent..........................106Physician Turned "Enemy of the People".................................110Middlemen: HMOs, IPAs, PPOs, Etc.......................................113Personal Practice Changes..............................................118Brain Drain and Loss of Resources......................................132The Solutions..........................................................138Epilogue...............................................................143Endnotes...............................................................147Suggested Reading......................................................151

Chapter One

My Family's Influences

* * *

I needed help with speech as a child, so my parents had me spend time over at Dr. Cheatle's house, a neighbor and family friend. He was a large man, but very kind, and I remember him lying in his bed with a smile on his face, always with a warm, comforting word for me. I never knew why at the time, but later I found out he had been put on bed rest for kidney disease.

"Come on in, Bill," he'd say. "Climb up here, and let's get to work."

A pudgy two-year-old with big, thick glasses, I would climb up on Dr. Cheatle's massive chest and sit perched there, while he carefully and slowly pronounced one word after another and had me repeat them.

"Poe-tae-toe," he would say.

"Potato," I would repeat.

"Toe-mae-toe."

"Tomato."

"Cahl-ih-flow-er."

"Cauliflower."

I don't recall how many weeks or months this went on, but I know this kindly man with the patience of a saint spent every weekday morning with me, for several hours, just repeating words and teaching me to say them correctly.

Dr. Cheatle was in the position to help me learn to speak correctly because he had the time. Ill with kidney disease, he had been told he had little time to live. At that time, sixty-five years ago, his physicians had thought that bed rest was the only treatment likely to help. His prognosis was grim, but the human spirit frequently beats the odds, and, in Doc Cheatle's case, he recovered, returned to his practice, and lived another twenty years.

This was my first introduction to a doctor, a physician, and a healer. The ingredients that made up this man were a sense of power, kindness, caring, patience, and dedication to a task, and that image of him never left me. Those integrated human characteristics stuck in my memory as the very likeness of what a medicine man or woman should be. Would I have learned to talk without his help? Surely. Would I have become a physician without it? Possibly. But would I have the sense of how a physician should be devoted, dedicated, and committed to people? Not likely.

Other Experiences That Shaped My Perception

Probably the earliest and most basic experience unconsciously pushing me toward medicine was my need, as a child, for very thick glasses. My visual problems were unknown at birth, but when I was about two, the diagnosis of astigmatism and hyperopia (farsightedness) were made, and I received my first pair of glasses. They were a godsend to me. My mother told me that once outside the ophthalmologist's office, I got down on my hands and knees to examine the cracks in the sidewalk, and picked up leaves to see them up close. I had not seen the fine images of the world until that time; only gross outlines and fuzzy representations. My glasses thus became important to me. Often, I would sleep with them on my face, refusing to take them off for fear that if I woke up unexpectedly and needed them, I wouldn't be able to find them.

I believe my unusually thick glass caused some people to assume I must be defective in other ways, for example, intellectually or athletically. In fourth grade, my teacher, Mr. Young, told my mother that, at the beginning of the school year, he had thought I would be "slow" due to my appearance and shy temperament.

"Only after time," he told her, "seeing that every time I asked Bill a question, he'd give me the right answer, did I realize he had a really good mind."

I was also a better-than-average athlete, but it took time for my coaches and classmates to appreciate that. I participated in many sports—baseball and basketball primarily—but often did not have the confidence to try out for a school team and thus to achieve my potential.

Unfortunately for me, my thick glasses internally altered my perception of myself. I thought of myself as ugly and different- looking. I remember, on one occasion, going into a restaurant with my parents, and as we walked by a booth where two elderly women were sitting, I heard one say to the other, "He would be a nice- looking boy if it weren't for those glasses." That and many other similar experiences, minor as they may seem now, insidiously caused me to be self-conscious and lack confidence.

My sophomore year in college, some of that changed when I began wearing contact lenses. My poor vision became less apparent, and others' perceptions of me less skewed. I do recall, with pain, however, an experience during my first few months in college that seemed to be history repeating itself. Colorado College, an excellent small liberal arts institution in Colorado Springs, had a college bowling team. I had become an excellent bowler at my high school in St. Louis, Missouri, the "Bowling Capital of the United States," having spent many hours in practice and winning a number of tournaments. I joined the college team and was immediately recognized as one of the best bowlers in the school.

I took pride in doing well at the sport. On one occasion, I scored exceptionally well, rolling almost a 700 three-game series (900 being the highest possible) and having a high single game of 298 (300 being perfect). At the time, it was the highest game ever bowled in the school's history. I was proud of that, and I do not believe smug. My pride was cut short, however, when a sportswriter for the school paper wrote, "Saucer Eyes Bill Evans rolled a near perfect game at the school bowling alley." Once again, my glasses, and not my accomplishment, had defined me.

Studies have shown that a high number of individuals who enter medicine have...