THE BLOG

Modern Medicine: Healing or Stealing?

A story of commitment:

A long time ago there lived twin brothers, Cosmas and Damian, both of whom were doctors. Trained in Syria they practiced as physicians in the seaport Aegea. Through their work, they attained a great reputation for healing. At some point, though it is unclear how or why, each had a mystical awakening and came to a simultaneous and mutual decision that eventually led them to be known as Cosmas the Moneyless and Damian the Silverless. They were venerated as the "anargyroi," the unmercenary physicians, because they decided to stop charging for their services and to heal purely out of love for God.

They had determined that their abilities as healers were gifts and that they would therefore give them freely and trust that God would provide them with what they needed in order to continue healing the infirm. They traveled throughout Asia Minor and never starved or lacked for anything, although they were brutally tortured and beheaded by order of Lysias for not recanting their beliefs.

That was in the third century.

Now, let me tell you a true story from the 21st century, a more modern counterpoint in a minor key:

Someone I know who was injured on the job was sent by the Worker's Compensation insurance underwriter to one of their approved rehabilitation physicians. It was a big office, with a full staff, colorful walls, a physical therapy program, a host of diagnostic machines and one doctor.

The patient was examined. The exam, which involved a simple "look-see," an x-ray and a few "walk, sit, bend and stand" commands, at first revealed nothing. Drugs were strongly encouraged, particularly Vicodin, which is a known hazard on a multitude of levels (tendency for addiction, narcotic bowel syndrome, irritability and mood disturbance, motor function disturbance and so on and so forth). They were all refused with the exception of ibuprofen.

Finally, after two months of increasing and relentless pain, the insurance company capitulated and allowed an MRI, which found several bulging discs including an impinged S1. The patient was exhausted, but relieved to know he wasn't crazy. At least the pain had a real etiology. They did other neurologic exams and found moderate to severe neuropathy along one leg, hip and buttock.

Although they continued to press the patient to take more drugs, they allowed physical rehab which entailed deep tissue release. After two months, the patient saw some signs of improvement. So what did they do?

They discontinued treatment, declared the patient at MMI ("maximum medical improvement") and sent him on his merry way with a prescription for whatever he wanted.

When the doctor told the patient that the physical therapy was being withdrawn, the patient sat stunned for a moment. "But that was the only thing that worked," he said. "How can you take that away from me?"

"Yeah," the doctor said, "but it's been too long now and we have to make a determination for the insurance company."

"But you're a doctor!" the patient leaned forward, raising his voice.

"I know. But that's the system," was all the doctor had to say and turned back to his very fashionable computer note pad.

Before the patient left, he looked back and pointed his finger, "No. You're the system."

The doctor went on to earn a lot of money and live very comfortably. So far he has not been beheaded.

Choices on Becoming A Healer

Why do people go into medicine? Or become social workers? Or psychologists? Or naturopaths and homeopaths? Why go through years of training and gruesome, unpaid clinical internships? Why not go into economics or weapons manufacturing or lobbying?

I know why my father did. He walked back and forth to the NYU medical school uptown campus every day from the north Bronx because he loved medicine. He loved the science of it, the magic of it, the relief it brought to people who were suffering. Now 90 years old and no longer practicing, he still becomes giddy just talking about it, still goes to grand rounds, still reads the journals from front to back, even the ads.

In those early days when I was very little, he got up when there was an emergency, picked up that worn, alligator bag and headed out for a "house call" (imagine that!) at three in the morning. He got paid for his time -- nothing wrong with that. But he didn't worry about what some bureaucrat was going to say about whether it was "warranted" or not. He went because he was needed. Even if it was more hand-holding than anything else.

I am as certain as I can be of anything in this fallen world that my father did not go into medicine to get rich or famous. He didn't have dreams of being on that day's equivalent of Oprah or being hailed as the great new magic man by The New York Times. He never imagined what the insurance companies would do to medicine. He did his job and took care of his family. He worked hard, took jobs sometimes that he didn't like so much and helped people out. As it turned out, we were never poor and that was enough for us.

Now it's a different story. Although I know there are many young people who still have the heart and soul to join Doctors without Borders or head out with the Peace Corps or sign up for clinic jobs with poor, hurting, sick people in small, dusty towns along the southern edge of New Mexico, there are way more who are vying for the top spots in the lucrative specialties (cosmetic surgery, dermatology) that will get them Park Avenue salaries, status and something to really Twitter about.

It's not all their fault, I admit. Expectations about doctors have changed on our parts, too. They're being trained by pharmaceutical companies instead of independent physicians. And we've made the fatal error of setting them up as demi-gods and demanding that they do the impossible. So now (as opposed to when my father had his practice) when something bad happens, we sue them. It's the McDonald's coffee cup syndrome. We stick burning hot coffee between our legs as we drive and then haul everyone but our own poor judgment into court. We eat too much, sit too much and whine too much. Then when we get sick, we want it to go away fast so we can eat too much again. If my father had had a patient like that years ago, he wouldn't have given him a pill. He would've read him the riot act.

What's happened to us? What's happened to doctors?

The Ultimate Disconnect: Doctors as Participating Providers instead of Community Members

The other day a patient told a story of how she got her first kitten. It wasn't anything like what one might expect. As it turned out, her family doctor was over for dinner with his wife and he had found a kitten.

"Your doctor came over for dinner?" I asked, truly surprised.

"Yeah, he always did. He was like part of our family," she sat back with her memory like she was reading a favorite old book.

"He was your doctor and your parents's doctor?" I wondered stupidly.

"Yeah, why?"

The last time I heard about a doctor visiting a patient's house to celebrate a social occasion was the last time I watched "Little House on the Prairie."

In modern practice those boundary crossings are utterly verboten. I know of one social worker (who's really an administrator, not a therapist) who won't even acknowledge a patient in public unless the patient comes up to him first, and even then he's as circumspect as a mouse in a cat house. And I can't remember the last time I was alone with a doctor. In both exams and fully-clothed, open-door consultations, there is always a nurse or assistant present as a live witness to ward off the evil spirits of the legal system.

There are rules and regulations about these things now, privacy laws and confidentiality acts that can put a therapist or doctor in jail for saying the wrong thing at the wrong time.

So, the caution is understandable. But it's also lamentable.

Because a while back I left the cloister and went to see a client walk to receive her master's degree. She invited me to do so and there was no doubt it meant the world to her. In my mind and heart it was the healing and loving thing to do. I could have said "no," that the regulations strictly interpreted limited our interaction to the office and that leaving those four walls could pollute the therapeutic relationship. But I didn't. I went. And we both wept as she got her degree.

To be fair, there are some good reasons for people being careful about leaving a traditional and "safe" setting. Many "healers" have taken terrible advantage of people by forcing unprofessional relationships on them with highly improper dynamics. And I don't just mean sexual ones. I mean ones in which the therapist is the needy one. And people like that sincerely do need lines drawn around them that read: "so far and no farther." But I suspect that we may have gone too far in our carefulness and become fearful. In so doing we may be losing something truly precious -- the healing relationship.

When I think of doctors as part of a community, I once again think of my father and what being a healer means.

It was winter when I was an infant and one of his patients had contracted a bad flu which took a turn for the worse one night. As the story goes, they called in the wee hours of the morning. Without hesitating, my father went to their apartment on Decatur Avenue in the Bronx, where he sat with Harry as his wife, Irene, paced until the fever broke. He sat there all night. Harry lived. Irene never stopped pacing, but she was eternally grateful and thought my father walked on water.

First they came to major family events -- birthdays, funerals and the like. But then they started coming over just to come over. He still took care of them medically. And they lived into their 90's, mostly hale and almost always happy.

It never occurred to anyone in my family -- immediate or extended -- that there was anything untoward or unethical about it. In fact, if that question had even been raised, they would have heard a resounding, "Are you crazy?" from all of us.

Doctors, therapists, priests, rabbis, pastors -- healers and helpers of all sorts -- used to be part of the community and a part of the lives of the people whom they served. They were respected and they were compensated for their time and their help, but they weren't expected to be rich. That was the province of robber barons, railroad men and mining companies. Doctors were expected to be like everyone else in the community. They were a part of it. They certainly weren't the emissaries of insurance companies and corporate boards.

Doctors didn't have to find different churches to attend because one of the congregants came to see them for a yeast infection. It was confidential, the relationship was sacred, yes. But there was other life to live, too. And people did.

In one of my talks on Verbal First Aid, I make a point of bringing up the stethoscope as one of the inventions that truly changed medicine and the art of healing. Because where once the physician had to lay his or her ear on the patient's chest to hear the heart beating, now there was over a foot of distance between them.

In our zealousness and fear, we have substituted machines for people, insurance forms and money for health and inflexible rules for sensible relationships. We have literally taken the heart out of healing.