“Some of medicine’s frailties are new; some are of long standing. But what the pandemic has exposed … is painfully clear. Medicine needs to do more than recover; it needs to get better.”
— Siddhartha Mukherjee, The New Yorker
Writing in the April 23 Salt Lake Tribune, Greg Elliott, M.D., quoted Theodore Woodward — our professor of medicine: “Believe half of what you read, and half of what you hear.”
I am a child of the early 1930s — depression, FDR, Hitler and much more. Medicine in those days was primitive as compared to now. Mostly, therapeutics were surgery, digitalis, aspirin, laudanum and a lot of hope. Antibiotics came in the late 30s. Much more than today, families struggled with suffering, disease and fear of early death.
In my family, with a dentist father, my memory is that hungry, homeless strangers knocked on the backdoor of our Chicago home seeking a meal. My mother would, hesitantly, give a plate of eggs and bacon through our back door. Many of the transient homeless probably had undiagnosed disease. That was an old normal.
Fast-forward to 1948 and another old normal: My family physician prescribed steam for my beet-red sore throat instead of sulfa or penicillin. I learned a few weeks later, he wasn’t up on his medical science, as I developed rheumatic fever and a heart murmur. Antibiotics were available in 1948, but he prescribed teapot steam. (Professor Woodward would probably say: keep up with your journals!)
After graduating from medical school in 1958, I carried these memories into internship, residency and radiology practice, beginning in 1963. Since then, medicine has changed more than earlier years. Insurance, for instance, became private — a lot of it provided by employers — and public with Medicare and Medicaid, serving the elderly and the uninsured — within authorized limits. (With the pandemic, the uninsured have no recourse. The ER or nothing.)
Other than tremendous improvement of medical science, the current “normal” during the pandemic shows many deficiencies — the system is bleeding from severe wounds. The pandemic altered regular medical care in favor of coronavirus care with emergency rooms erecting tents to triage patients depending on those sick with the virus and those with other illnesses. Care for non-COVID-19 patients, such as heart disease, cancer, diabetes or elective surgery, has been cut.
The Mayo Clinic projected losses in 2020 of $900 million as compared to profits of $1 billion in 2019. Mayo has furloughed workers and cut doctors’ pay to control the hemorrhaging of income.
In a April 6 Salt Lake Tribune commentary, board chair Gail Miller and CEO Marc Harrison report Intermountain Health Care will cut pay of contract providers who are seeing 30% to 50% fewer patients and redeploy “some hospital-based providers [to] … InstaCares or our tele-health service, where volumes are high.”
The American Academy of Family Physicians surveyed their members, learning that 48% have cut employees hours and 22% have laid off employees. How will our medical system manage this recession? What changes will occur as thousands are dead and millions threatened?
Employer-based insurance omits the unemployed. The unemployed need medical care, but millions — 38 million and counting — are bare for all illness. Many jobs have evaporated. Donald Berwick, former administrator of the Centers for Disease Control, said in the Journal of the American Medical Association, "This pandemic will force us to consider reform in our health care system with greater emphasis on public health, safety of our medical workforce and virtual medical care, using Skype or Zoom. Also, we should ratchet down the inequities to the disadvantaged.”
The “new normal” should include these goals.The upcoming election is the key to the future. Without a progressive leader and Congress, we can only expect more of the same; Trumpian Republicans focus on profits and the economy — not serving the needly or distressed.
Now is the time for medical reform. As Victor Frankl said years ago in his book “Man’s Search for Meaning,” “Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”
Reform of the practice of medicine can come from this COVID-19 natural disaster. As Mukherjee said in the quote above: “Medicine needs to do more than recover; it needs to get better.”
Richard H. Keller
Richard H. Keller, M.D., Salt Lake City, is a retired radiologist, formerly chief of the Cottonwood and Alta View Hospital Radiology Departments.