New York Magazine recently put together a panel of doctors to anonymously talk about mistakes, why patients wait so long, hospital conditions and similar subjects. It's interesting stuff, especially this part about the relationship between healthcare providers and Big Pharma:

Are doctors unduly influenced by drug companies?

Dr. Virus: I don’t think that doctors make dangerous decisions because of the influence of the drug companies. But I think we make very expensive decisions. There’s an antibiotic for $10 and there’s an antibiotic for $150. I had dinner last night with the $150 guys, and it might be theoretically marginally better. There might be reasons that I prescribe it, and one might be that I liked my steak dinner. You’ll get well either way on the cheap one or the expensive one, but this way I’ll have another steak dinner. It’s low-level bribery—there’s no question about it. I used to go out to dinner with these guys, and I stopped because I found it too gross for words.

Dr. Lung: I used to be in charge of a department, and I told my unit that I’m not going to support big dinners where they take twenty doctors out. If you’re friends with one particular rep, then you can go as friends. But I’ve always felt that they’re expecting something in return.

Dr. Heart2: I am wooed. You know, all doctors are wooed. But the true excess is not in the pens and the steak dinners. It’s the relationships pharmaceutical companies develop with hospitals that are much more nefarious than buying a doctor a steak dinner. Companies strike deals with hospital pharmacies to provide their drugs at a low cost to get patients using them. Then they price the drug at a later date any which way they want.

As much as I can't stand the way Big Pharma uses perks and freebies to make doctors like them, "Dr. Heart2" is correct that the real issue is when a pharmaceutical company makes a deal with a hospital that effectively locks a hospital into using a particular drug for economic reasons - and only short term gains at that.

What really stood out to me, though was the last question:

What could be changed about the health-care system to better help patients?

Dr. Baby: Universal health care.

Dr. Heart1: But you’re talking from a public-health perspective. If you are an individual … if your dad is sick and he has access to insurance and money, do you want him to live in the country with universal health care or our kind of health care? Our kind of health care.

Dr. Virus: The only place I’d defend American care is for the catastrophically ill, where there are miraculous outcomes still.

Dr. Heart2: If you’re talking about separating Siamese twins, yes, I’d want to do it in the United States rather than anywhere else in the world. When money is not an issue, I would still contend that we have the worst, because we get overtested. We chase incidental diagnoses that might not affect the patient’s health.

Dr. Virus: With universal, you’d get the same kind of mediocre shittiness that you’d get in all other kinds of standardized approaches. But for millions of people, that would be a big upgrade.

It's funny to that doctors who have been having an in depth conversation about the massive shortcomings of our health system - not enough nurses, shady financial dealings from hospitals and pharmaceutical companies, etc., all the sudden shift gears when the subject of universal healthcare comes up. "Oh no, quality of care will go down!" I suppose if you believe that universal healthcare means, instead of only one nurse for an entire floor of acute patients, there won't be any nurses in the hospital at all.

The evidence is of course quite different, with the crazed stories about Canadians waiting 14 years to be seen for a sore throat and the French, I don't know, surrendering all the time just to get foreign doctors in the place or something, shown over and over to be merely scare tactics and propaganda. It just shows that doctors are not infallible gods, and an MD or DO does not bestow expert knowledge about everything, not even every aspect of healthcare.

For example, my family doctor is an excellent doctor. We've been her patients for 12 years now, and we love her. She's the best doctor I've ever seen or heard of. But I know more about health insurance than she does, both in terms of the present system and in terms of what universal heath care means in other countries and what it would mean here.

When it comes to crafting a healthcare policy for this country, doctors should be consulted about methods and levels of care, that type of thing. But they're practitioners, and should only be considered as such, not experts in paperwork, bureaucracy, delivery systems and similar issues. This country would be well served to remove doctors from the enormous pedestal upon which we've placed them.

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