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Boutique Medicine?
NMB, Florida January 17, 2002 A.H. Schectman
THINKING ALLOWED
Essays on Issues, Ideas and Reflections on the Times. Published Now and
Then. Opinions Pro or Con Are Welcome.
BOUTIQUE MEDICINE?
As I finished my essay on "Gatekeepers" I glanced once more at the NY
Times' Editorial Page and saw the piece on "Boutique Medicine". I read and
heard about the idea that if people would pay, doctors would charge more for
special service. This idea is destructive to the foundations of medicine
going back to Hippocrates whose Oath makes us all feel a lot easier about
being sick and needing help.
If people want and can pay for it they buy huge gas guzzling cars to show
by conspicuous consumption that they have arrived at some human pinnacle of
achievement. If people buy huge homes surrounded by acres of precious land
just for themselves - and can pay for it - this seems to me to be in the
nature of the kind of civilization we want and have constructed.
I draw the line, however, at special medicine for special people. Now, let
me clarify. I think that the most obscure medical problem identified should
be pursued by the same dollars that keep the rich smug and satisfied. I
note that there are conditions and diseases that are not profitable so
research into cures is not pursued. The dollar is the gatekeeper here. If
you have that dollar then you are allowed to go into the doors of the
hospital that has the cure for you. All others wait in line at the clinic.
Now, yesterday I didn't go to a clinic. I went to my allergy /pulmonary
specialist. He happens to be a bone Doctor. You know, the "Osteopaths" who
now are trained the same as the real doctors. The best recommendation for
me is that his office is across the street. I know that my internist is
hard to get a hold of and has limited his practice to only a few he likes to
practice on. We are part of the few and an appointment with him is usually
made far in advance and I needed a doctor RIGHT NOW!
My allergies had me down on my back with my eyes, ears and nose clogged or
running at the same time and I felt lousy. So I went last week to the
doctor across the street and he saw me after a long wait. He is very good
at going into his closet and bringing out a bag of nose sprays and other
medicines.
Yesterday I awoke so sick Carol made an appointment for me. I had to first
take the car in for a necessary check up and begged for quick work and
really suffered while waiting for the car to be produced. George, the
specialist in fixing my cars at Chrysler, saw how miserable I was and
speeded up the process JUST FOR ME.
I next went to the doctor's office and took my place in a line that seemed
to go from last year into the next century. There were your tired, poor,
sick and misshapen people if there ever were. I fit right in. Most of us
were old and some were equipped with wheel chairs and walkers and canes. I
came with my handkerchief and book to read and wished for a box of Kleenex.
It took forever - and despite my being shoehorned in early those who came
after me were taken first and again I was last to be seen. I left with the
waiting room empty of those who wait.
Now my proposition is this. I am willing to pay more if the doctor - like
those of my childhood - will be willing to come to see me rather than me
going to him to take my place in a line. Boutique Medicine? Well, no - not
exactly - just old-fashioned old-time doctors with their black bags visiting
me at home.
Carol's Evaluation: 10 out of 10.
Post-script. Have you ever noticed that there are some people who arrange
your time to fit their needs? And, you stand for it? I have this idea if we
had more doctors they could halve the waiting time and still send their kids
to the best schools. And, there still could be the few "Society Doctors" who
see only the rich and famous and make a great many more dollars than those
who run clinics. It all seems to come down - in today's way of doing such
things - to charging everything to the Government Social Security, Medicare,
Medicade services.
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