Time To Care

Dr. Norman Makous

It sometimes seems as though Medicare has been a standard part of the scene for so long it now needs major reform, but when a doctor has practiced Medicine for sixty years he has seen a lot of contrasts between the old way and the new way, not all of them favorable to the new -- which we are now tired of, and trying to repair. That's particularly true if the doctor practiced at America's first and oldest hospital, because it sustained many traditions from two centuries before, and was among the last to yield to the imperatives of newcomers for the last forty years, their hands grasping for the purse strings. Dr. Norman Makous must either have a remarkable memory or a thick, detailed diary. He tells three hundred pages of fast-reading anecdotes about sixty years of his own medical practice, before summing up in fifty pages of reflection. One by one, he describes the innovations in his field of cardiology and how they affected him and his patients. Thiomerin, one of the first of many easy ways to pump out excess body fluid accumulation, transformed the treatment of congestive heart failure. Synthetic digitalis claimed to but probably did not much improve things over dried digitalis leaves; it certainly raised the cost. Cardiac catheterization, electro-shock resuscitation, ultra sound diagnostics, MRI and CAT scans, cardiac surgery using the heart-lung machine, and finally cardiac transplants -- all started out as headline-news spectaculars, evolved into cutting-edge advances, and then settled down into the Standard of Care that you obtained a plaintiff lawyer to sue about. All in one medical lifetime, supposedly prepared for by one Medical School course, followed by one residency apprenticeship, the specialty of Cardiology was completely transformed at least six times.

Time to Care

Meanwhile, the leadership of the medical profession was tenaciously resisted by those who supposedly followed its direction. Hospital administrators, either trying to reduce costs or to maximize institutional reimbursement, and sometimes just trying to glamorize their corporate vehicle; million-dollar-a-year salaries for administrators probably held out some perverse inducements, as well. Nurses, cut loose from hospital training programs to invent a new profession of nursing administration within university campuses remote from the scene of sickness. Health insurance executives, trained in the art of income maximization by Business Schools, driven by the need to lobby and the need to accommodate quirky laws lobbied by others, pressured by corporate human resources departments who were in turn pressured by unions and corporate managements -- and constantly bothered by expensive new technologies invented by doctors "who needed new toys". University administrations, placed in charge of numerous recalcitrant medical staff physicians, applying the principles of the German research systems upon an intransigent profession that persisted in preferring the care of sick people to the chase for research grants. And politicians, elected for two-year terms in which they felt pressure to accommodate a hundred conflicting interest groups.

Against all this and more, Dr. Makous describes how the practicing physicians especially those trained in the traditional way, found only one sympathetic, kindred interest group -- the patients. During a period when everybody else seemed determined to snitch a piece of the health insurance money pie, the patient wanted one major thing from the doctor. He wanted to be helped through his illness. The patients loved their doctor, in what was known as the patient doctor relationship. But a strange thing was also true. The doctors loved their patients, the only group in society who seemed to care what the doctor was trying to do.

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