Volume 14, Issue 1, Spring, 2007
Life Is Like That
We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
-“Gerontion” by T.S. Eliot
At the end of my lifetime in medicine, I once again seek wisdom from such great English poets as T.S. Eliot for insight. My career has spanned an era of incredible developments. So it seems appropriate to reflect on where I have been and to understand the truth in Eliot’s words quoted above.
The readers of this piece know better than I the amazing new technologies and procedures and drugs that have evolved over the last forty years. Here I will rather consider the ways I have seen health care and medical practice change — in some ways for the worse.
As I look back, I often feel fortunate — sometimes even a little guilty — over having lived in what may have been the best of times for the practice of medicine. Partly that has been the result of having practiced only in institutional settings, first in the Navy and then in a second career at UW. In this way I have been largely sheltered from the growing challenges of private practice.
Also, I have been greatly privileged to work with my gifted faculty colleagues and side by side with the brightest and most dedicated residents available from across the country. I have enjoyed all of these advantages.
The problems I see are more in the way health care is controlled and financed. Control has been politicized, turned over to the pharmaceutical and insurance companies, which fund political campaigns, in return for which they get great freedom to operate as they wish. One predictable result is increasing corruption of the medical profession, with some companies even ghost-writing articles for publication under a doctor’s name in peer-reviewed journals. All the while, the country seems to feel that, while it is the most expensive system in the world, at least we have the greatest care.
But is that really true? We have the second highest infant mortality rate in the developed world. At the other end of life, we have about the twenty-seventh from the best longevity. Between those benchmarks, we spend incredible costs on many patients’ last two weeks of life, and there are 90,000 preventable hospital deaths and serious complications from poorly controlled use of drugs. And 47 million Americans have no insurance to pay for their care.
I didn’t intend for this to be a rant against the current state of health care in our country. The acute care of most patients is excellent. It is the system that is badly broken. We need universal insurance to pay for everyone’s care, which can be done at far less cost than the present profit-driven system. But I guess that is a different story.
For now, I am no longer certain that I am looking back at the same field that I explored over a lifetime. Perhaps fifty years from now a new generation of surgeons will learn another lesson but will see the same wisdom from Eliot’s poem.
by Clifford M. Herman, M.D.
Professor Emeritus
Surgery Residency Program Director, 1987 - 1994