I finished my residency in dermatology at the University of Miami/Jackson Memorial Hospital in July 1974, and started a solo private practice in Miami, Florida. It became obvious to me very quickly, that there were things that physicians had to know which were not taught in medical school or residency training programs: these were things about patients, and about other doctors, and about hospitals, and about pharmaceutical and medical laboratories sales representatives.
After just a few months into private practice, South Florida witnessed the first big malpractice crisis, after the first million dollar jury awards in the nation. All the malpractice companies stopped selling policies in Florida with only two weeks notice, and the State developed a program, the Patient’s Compensation Fund, to provide some quick relief. That program lasted only two years.
The First Cat Scanners were being sold to doctors and businessmen in South Florida, and the local Health Planning Council had to give permission to hospitals who wanted to purchase one. A large hospital, Mercy, was denied permission to buy and install one, yet a small group of doctors were able to buy and install one in an office on the Mercy Hospital grounds. They became millionaires and many of their patients were given scans.
Along with cocaine abuse, prescription drug abuse was becoming rampant, and businessmen set up clinics, called Quaalude Clinics, where a hired doctor gave a prescription for 30 Quaalude tablets, for $25 cash to anyone who walked in the door. The tablets could be purchased at any pharmacy for 10 cents a piece and then sold out on the street for $25 a piece. Dilaudid tablets, could be purchased for 30 cents at the pharmacy and then could be sold for one hundred dollars each to heroin addicts on the street corner. Some of these hired physicians were old and senile and they eventually had their medical licenses taken away, while the businessmen owners moved on to other deals.
Then I read an editorial in the New England Journal of Medicine by Dr. Robert Coles, a theologian and physician, called Medical Ethics and Living a Life*, where he told about how some physicians had been portrayed in literature, and how their initial idealistic outlook as physicians had been changed by the real world, by the pressures to make money and look successful in the eyes of their families and friends and society.
Dr. Coles wrote of the fictional doctors Dick Diver in Tender is the Night (F. Scott Fitzgerald) and Thomas More in Love in the Ruins (Walker Percy). “Those physicians have asked important questions about life, how to live it honestly, decently and their “fall” troubles us. Those two principal characters speak for….how significantly each physician’s career connects with his or her moral values.”
I was so perplexed and troubled by the way CaT scanners were being allocated in Miami, that I wrote a story, in the form of an animal fable, The Weasel and the Cat Scan, the was published in the Journal of the Florida Medical Association in March 1979. I wanted it to serve as a metaphor for doctors who became entrepreneurs, and point out how the health care system, and especially physicians, were becoming consumed with the profit motive.
The Governor of Florida, Robert Graham, read my CaT scan fable, and appointed me to the Florida Board of Medicine in October 1979, at age 37. As a member of a nine person board that granted medical licenses in our state, and disciplined and removed bad doctors, I was suddenly exposed to the grimy side of medicine on an almost daily basis. I was shown doctors who were senile and incompetent and still taking care of patients: doctors who sold drugs: doctors who performed procedures for which they had no training or skills; doctors who cheated on billing insurance companies to earn more money, and there were doctors who knew that other doctors were incompetent or dishonest and did nothing about it. I served on the Board of Medicine committee that dealt with impaired physicians and another committee about nurse practitioners, a then newly developing category of health care provider
As a member of the Florida Board of Medicine, I became a member of the Federation of State Medical Boards and joined their committee that studied the development where U.S. Citizens were attending special foreign medical schools in Latin America because they had been unable to get into U.S. medical schools. I wrote another animal fable about this issue, Sloth Breaks the Queue.
In September 1980, I became Editor of the Dade County Medical Association journal, Miami Medicine, and began writing editorials about all the issues that burned within me from my experiences as a practicing physician, and as a member of the Board of Medicine. I became an associate Editor of the Journal of the Florida Medical Association, and of the Federation Bulletin, the publication of the Federation of State Medical Boards. In l981, I became a member of the Board of Contributors for the Miami Herald newspaper, and began writing about one editorial a month, on health issues, until l992. In 1984, I became Chairman of the Caduceus Malpractice Insurance Trust, and served until 1999. This gave me great insight into the malpractice issue, and to plaintiff lawyers and the Caduceus’s insured defendant doctors, many of whom were being sued for no reason at all.
This book of 83 essays and stories, all come from those publications, and the reader may ask what is the relevance of materials that were written over 25 years ago. The issues written about in these stories are timeless; about how doctors are human and how they treat their patients, and how they are affected by human desires for wealth and success, and how they can be seduced by female patients, and illegal drugs and large sums of money, and how their patients, as humans , also are motivated by self interest and how they sometimes try to tempt the doctor into behaving badly. Aristotle and Hippocrates knew about these situations, and Dr Coles tells us that Sinclair Lewis, in Arrowsmith, and George Elliot in Middlemarch, as well Scott Fitzgerald and Walker Percy also knew.
Doctors must continually think about their lives and their practices. They should try to be the best and most decent doctor and person that they can. They should continue to attempt to improve their medical skills, but also improve their ability to stay focused on avoiding temptations and, according to Dr Coles, by trying not to “fall”.
* Coles, R. Medical Ethics and Living a Life N.Eng J of Medicine, Vol 301 August 1979
|