Sunday, November 24, 1996
Health care? Docs say it's sick

BY LAURA PULFER
The Cincinnati Enquirer

Last summer, I was uppity enough to lecture the physicians of this city. Then, when I was not struck by lightning, I sent my little message out all over the country. The next thing I knew, I was getting e-mail from all over the world. So, I'm afraid I can't get sick anywhere.

I'm kidding. I'm kidding. The docs were really pretty nice, considering that I noticed publicly that they are no longer in charge of health care. Not that this was a big secret. How many doctors do you know who would have come up with the idea of drive-through deliveries or drive-by mastectomies?

Dr. Herman Hamersma of South Africa, however, ''applauds'' my wisdom very much. I do not believe that English is his first language, and I have noticed that I can appear to be very wise if no one understands what I am saying.

Doctors talk back

Actually, I was saying how smart I think doctors are. So, I wondered why they were letting everybody else tell them how to do their jobs. They wrote and faxed and called to tell me.

''We 'smart kids' are doing pretty well these days just to practice competent medicine,'' writes Dr. Stephen Eby of Monfort Heights. ''Now you want us to manage insurance companies, government agencies, law firms and legislatures.

''I deal with 701 (actual count) different insurance companies with their varying rules, panels, inspections, credentialing and participating hospitals. In the meantime, I do see patients.''

''Most doctors,'' according to Dr. William M. Klykylo of Finneytown, ''had no reason to learn much about business since our living was so flush, and we were busy with our patients. We bleated again and again about capitalism, then finally got a big dose of it.''

On top of that, this isn't what they signed up to do with their lives.

''Pitting some of these docs against the HMO giants, insurance companies and legislators is like sending a Christian to the lions,'' says Tina Farrell, whose husband is a doctor in Kentucky. Not to mention that if they're doing battle with some HMO bean counter, they can't be taking care of good, old irreplaceable me.

A Little Rock, Ark., physician writes, ''On my desk right now is a stack of seven charts awaiting letters to insurance companies. These letters will beg, plead, implore and cajole them to allow a test they say is unnecessary.

''The people to whom I write these letters have never seen my patient. They are armed with graphs, tables and actuarial data.'' Since they pay the bills, he says, their statistics trump his training.

Patient, heal thyself

''When a mom came into my office,'' Dr. Gary Fleming, a retired Athens, Ga., pediatrician told me, ''I'd listen to what she was saying. But I'd watch her eyes.

''Sometimes she'd sound all collected and calm, but I'd see fear. Then I'd keep asking questions until I found out what was really going on. Of course, you have to know somebody pretty well to do that.''

Of course.

Many doctors talked about their relationship to their patients. ''I worry,'' says a local oncologist, ''that young doctors will never know what a strong diagnostic tool an unhurried conversation can be.''

They're not too proud to ask for help. ''We do not need doctors and patients to be managed,'' Dr. Rodney Pollary of Salt Lake City says. ''We need to help patients learn how to manage themselves.''

''We do not provide health care,'' Dr. Klykylo insists. ''You do that by exercising, eating well and avoiding bad stuff. What we do is fight disease, mainly with technology.'' Expensive technology, he points out.

''If you want someone to rescue medicine,'' Dr. Eby says, ''I suggest you pick up your phone and call your boss, your congressional representative, your hospital board, your union and your insurance company and voice your opinion.''

You could probably get those telephone numbers from your physician. Maybe she has already dialed them three or four times today. Wouldn't you really rather that time was spent with you instead? And wouldn't you really rather help cure a sick system before you have to ask the system to cure a sick you?

Laura Pulfer's column appears in The Enquirer on Sundays, Tuesdays and Thursdays. Call 768-8393 or fax 768-8340. She can be heard Monday mornings on WVXU radio (91.7 FM), and as a regular commentator on National Public Radio's Morning Edition.

Published Nov. 26, 1996.