Tuesday, July 16, 1996
Why aren't more doctors on the case?

BY LAURA PULFER
The Cincinnati Enquirer

TO: PHYSICIANS FROM: A PERSON WHO OCCASIONALLY GETS SICK SUBJECT: HEALTH CARE

Please permit me to be blunt.

Isn't it about time you rescue medicine from the questionable mercies of business and politics? You were the smartest kids in the class. So what happened? Why are you letting everybody else tell you how to do your job?

Most of us are acquainted with dullards who became journalists and lawyers and insurance executives. But I can't think of a single instance when I've heard somebody observe, ''Geez, did you hear that Buzzy Binkley became a doctor? I always thought he was a little slow.''

You people who became doctors were the good students, the bookworms, the Merit Scholars, the brains, the Boy Scouts, the hall monitors. You were the ones whose homework the rest of us copied. Because you had the answers.

You are the people who have an arrogance so magnificent that you can put your hands around a pulsing human heart. You are the people with the grit to triage a bloody battlefield, to decide who will live and who will die. You are the voices that give the bad news. You are the ones we trust with our babies.

Only for you would we have worn those drafty paper robes, sitting on your cold examining table. Only for you would we have waited in a room full of sick people and elderly magazines.

Who's in charge?

So what's the problem? Are you scared of a bunch of bean counters? You whipped their butts on the SATs. And now they're making medical decisions ''in consultation'' with you. Consultation? Why aren't you running this show?

Are you really prepared to become just another employee?

Why have you allowed insurance companies and managed care to demand that young couples leave the car running when they enter the maternity ward? I'm not saying all new moms need to hang around the hospital for three or four days. I'd just like for you to be the one to decide when they go home.

Now, in addition to shorter stays, hospitals are planning to use fewer nurses. Are you going to let hospitals cheap out on the people who care for us when you're not there?

Of course, hospitals are just buildings and traditionally have been run by administrators. But you have always been in charge of patient care. You and the nurses.

What's going on here?

To be fair, hospitals are simply doing what they've been forced to do - compete, cut, downsize. Stay alive. In 1994 and 1995, the area's largest hospitals started two competing alliances: TriHealth and the Health Alliance of Greater Cincinnati, which includes University, Christ, Jewish and St. Luke hospitals.

So where have the docs been? Have you sent your best and brightest out to do battle, attend the meetings, work on the committees? Have you been pushing for us?

Is it the money? Is it us? Are you tired of taking care of us? And our untidy illnesses? Does it honk you off that Shaquille O'Neal might get $97 million to dunk round balls, and you still owe money on your med school loans?

So, maybe business is not your cup of tea. Maybe you hate meetings. Maybe you don't want to become personnel experts or crunch numbers. Fine. That's OK. You can hire somebody to do that.

''Up until now, there's been no force that has caused doctors to look and evaluate cost,'' says Dr. Ronald Drasnin, president of the Cincinnati Academy of Medicine. But he says physicians are forming groups to deliver care and to collect their own data.

Strength in numbers.

I'm glad to hear that, because when I get sick, I'd still like to know that there's a doctor in charge. Not some MBA, not a benefits manager at Procter & Gamble or Kroger. I sure don't want Hillary Clinton or Newt Gingrich or Ted Kennedy to be taking my temperature.

You will notice that I have a lot of questions. Do I have the answers? Of course not. I was not smart enough to be a doctor.

Laura Pulfer's column appears in The Enquirer Sundays, Tuesdays and Thursdays. Call 768-8393 or fax at 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.