Preserving American Values

Carl Sandburg wrote a poem expressing the public’s negative attitude towards lawyers that has the arresting line, “Why does the hearse horse snicker hauling a lawyer away?” The poem was presented to us as first-year law school students at the University of Chicago as a reminder that we should be compassionate in our law practice, to help those who cannot afford to pay, to deal with our clients as people rather than just a source of billing hours, and to contribute our talents for the wellbeing of our community. Back in 1965, we were in an indirect way told that lawyers should be more like doctors.

How times have changed. While of course there continue to be compassionate doctors of the old school, it seems the average contemporary doctor is a very different animal. Doctor groups today (the sole practitioner of yore is almost extinct) seem concerned mostly with how much money they make, which translates into seeing as many patients as possible in a given amount of time and finding ways to bill patients (and their insurance companies) for as many procedures, tests, and consultations as possible. Because of this business emphasis, they don’t know their patients anymore.

Doctors like to blame the federal government and insurance companies for this transformation. They say they have so much paper work to do that they have little time left for doctoring, and that the fees they are paid are so inadequate that they have to charge as many billing items as possible just to get a decent financial return.

Yet despite the fact that there is certainly some truth to that, doctors are on average extremely well paid (more than lawyers), and many specialties have an average income of almost half a million dollars.

No, the main culprit is that doctors have become capitalists. Both in their practice groups and in most hospitals, the healing profession has become a for-profit corporate entity whose main concern is the bottom line. As such, they find every conceivable way to milk money from their patients/insurance,  just like one would expect from a corporation. And the relationship between doctor and patient has been transformed accordingly. Small wonder that some now refer to the Hippocratic Oath that all doctors take as the “hypocritic” oath.

Many doctors don’t seem to think anymore, to think about what their patient is experiencing – given their knowledge of the patient – and decide how best to address the problem presented. Instead, if you’re lucky, the doctor will apply “best practices” by rote. I say “if you’re lucky,” because best practices are not the norm but the aspiration in the profession today. As for an holistic approach, the doctor who takes such an approach today, because it requires both a philosophy and knowing his or her patient, is the exception. It did not use to be so.

Bottom line … doctors and hospitals should not be profit centers. That orientation is inimical to the ideals of medical practice and caring for patients. By all means, doctors and others involved in the profession should make a good living because they provide a valuable service to people and society. But beyond that, to profit from one’s patients should raise ethical questions.

Why does the hearse horse snicker when hauling a doctor away? Isn’t it obvious!