By: Marilyn M. Singleton, M.D., J.D.
During a discussion on the future of health care, a clinician-turned-healthcare-executive told me that the way we “deliver health care” (not the same as “practicing medicine”) will change. It will be a “process”—a more mechanized one.
She spoke enthusiastically about the advantages, such as electronic health records. These can improve fraud detection in government programs with computerized cross-checking of services delivered and payments made. This of course misses a larger point. If we didn’t have enormous government programs, fraud would not be so easy to perpetrate. It’s pretty hard to double-bill a patient when there is no middleman. Patients generally remember whether they were in the doctor’s office last month. A patient who was not in a coma would immediately let the doctor know that she did not have that colonoscopy.
The executive was not concerned about the erosion of privacy. These days, she said, all of our information is in the ether anyway. If you are a random person, no one cares about your information. She did admit that the revelation of some conditions such as AIDS could lead to discrimination. The prospect that electronic enthusiasts don’t seem to see is that someone who is a “nobody” today could aspire to become a “somebody”—if it weren’t for that pesky counseling that now has her labeled as a mental defective. Let’s not forget that the government will get that information it labels as “preventive medicine,” such as the question about whether there is a gun in the house. What if your patient is the wife of a law enforcement officer and tells the truth? Has she just made her husband a target of disgruntled perpetrators?
What concerns me most is Americans’ quiet acquiescence to the intrusive nature of many health regulations. Putting the best construction on it, the continuing explosion of heath care regulations may be motivated by a sincere desire to improve the health of every American. But might they be used as the tools of another agenda: to make us feel secure enough to let down our guard as we become ever more dependent on the federal government?
Disturbed by this conversation and by the outcome of the fiscal cliff bullying, I was glad to try to escape reality by watching the Twilight Zone New Year’s marathon. But what I saw was the episode in which some philanthropic aliens came to earth and promised to eradicate famine and war. The aliens became the earthlings’ new best friends; they invited humans to visit their planet and enjoy a life without worries. The scientists managed to translate the title of a book the aliens brought with them: To Serve Man. The earthlings were now fully convinced that the aliens had our best interests at heart. Just as the last previously doubting Thomas was boarding the spaceship, his assistant frantically tries to get him to turn back, screaming that To Serve Man is the title of a cookbook! Rod Serling’s voiceover cautioned that we had gone from being the rulers of the planet [i.e., our medical practice] to an ingredient in someone’s soup.
Does this sound familiar?
Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and Association of American Physicians and Surgeons (AAPS) member. Despite being told, “they don’t take Negroes at Stanford”, she graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. She was an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before returning to California for private practice. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. Dr. Singleton recently returned from El Salvador where she conducted make-shift medical clinics in two rural villages. Her latest presentation to physicians was at the AAPS annual meeting about challenging the political elite.