Easy Chair — From the August 2016 issue

Atlas Aggregated

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No social encounter delights me more than meeting a doctor at a cocktail party. In clinical settings, doctors tend to be guarded and aloof. Catch one with a whiskey in hand, though, and you might find yourself in possession of all sorts of inside information. Among the nuggets I’ve gathered in this fashion are: that salt and butter aren’t really bad for you; that nicotine is a marvelous antidepressant; that vegans are no healthier than the rest of us; and that early cancer screening may be pointless, since many small tumors vanish on their own and some grow so slowly that their human hosts will die before they do major harm. Some of this may be inaccurate, perhaps, but most of it is worth repeating at other parties.

Last May, at a party in Las Vegas, I found myself chatting with a surgeon, the type of doctor I most idolize. Along with fighter pilots, surgeons represent to me the pinnacle of courage, self-mastery, and independence. They are the elite of the elite. This one, however, whom I’ll call Dr. Dave, felt deeply disgruntled and unappreciated. He assured me that these feelings were common in his field — he had been a head and neck surgeon who specialized in facial reconstructions — and were part of the reason he’d retired early. Dressed in the kind of loud Hawaiian shirt often favored by men who’ve flipped off the system, he blamed his foreshortened career on what he termed, with patent distaste, “consumer-driven medicine.”

The situation, he said, was this. About a decade ago, hospitals began distributing patient-satisfaction questionnaires designed by the Department of Health and Human Services. In 2010, the Affordable Care Act linked Medicare reimbursements to a set of quality-of-care measurements that included patient-satisfaction scores. A few years before, Dr. Dave had left private practice in part because insurers were paying solo doctors less than big hospitals. At the hospital, he felt pressure from administrators to keep his scores up. This meant catering to his patients’ whims, and sometimes to their neuroses and addictions. As “a slave to opinion,” he found himself ordering unnecessary tests to head off complaints from anxious, demanding types. He continued to treat people after they were well. He also grew reluctant to give advice that, though medically sound, might cause offense. Once, when he urged a patient to lose weight, Dr. Dave was accused of calling him fat. Then there were the patients whose aches and pains he diagnosed as symptoms of depression. They sometimes took umbrage, driving down his grades.

Dr. Dave went as far as blaming our prescription-opioid epidemic on the questionnaires, which sounded like the kind of cocktail-party medical chatter whose reliability seems questionable in the sober light of day, until later research showed that many experts agreed with him, including one doctor who linked the scourge, in an article for the Boston Globe, to the “era of patient-satisfaction surveys.” To Dr. Dave, though, there was a larger issue: the creeping usurpation of his authority by people who hadn’t a clue about his craft, let alone the workings of their own insides. Here he was, a highly skilled practitioner who’d once replaced a child’s missing ear by growing tissue on the child’s own head and then delicately harvesting and shaping it, being critiqued by laymen, by amateurs, whose only qualification to judge his work was having ears. It was crazy. It was upside down. In the name of empowering the patient, the physician had been diminished, deposed, degraded.

“When you go to a Starbucks, you’re pretty sure whether you got a good cup of coffee,” said Dr. Dave. “But if you have your appendix taken out, you only know what kind of job they did by whether the scar is pretty.” He took a sip of his drink and shook his head as if to wish his old profession good riddance. His Hawaiian shirt blazed with annoyance. I felt for him. Thirty-five years of training and experience thwarted by our belief that the customer is always right, even if the customer is stupid or addicted to prescription narcotics.

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October 2019


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