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Howard A. Zucker, MD Headshot

Just What the Patient Ordered

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Neither the price of chocolates nor flowers will skyrocket this Friday as the nation celebrates Doctors' Day. Since its inception in 1933, commemorating the March 30, 1842, discovery of anesthesia by Crawford Long, the medical profession has undergone astounding transformations. In 1933, the Nobel Prize in Medicine went to Thomas Morgan for a revolutionary concept now taught in grade school -- that chromosomes play a role in heredity. We soon will be able to map our genomes for a thousand dollars as a result of DNA sequencing and personalized medicine.

But how personal is medicine today? Was the 1960 television's Marcus Welby-style general practitioner better able to treat the entire patient than TV's present day self-styled diagnostic-genius Dr. House?

As current physicians age and become patients themselves they are experiencing the health system from the other side of the bedside. They are part of the new old. Of the nearly one million doctors in America today, close to 200,000 are senior citizens. They benefit from Medicare, a program enacted during their prime years of practice. Now, with the legality of the Obama administration's Affordability Care Act before the Supreme Court, the implementation of electronic medical records, and the marvels of face transplantation no longer science fiction, the opinions of a vanishing breed of doctors on these and other changes may be worth hearing.

It is time for America to take directional cues from Steven Spielberg by creating an oral history of the medical profession. These gray-haired, furrowed-brow physicians may illuminate how we might meld the best of the past and the promise of the future of medicine.

In 1960 the majority of doctors were in solo practice, providing attentive quality care. However, solo practice grew victim to overwhelming insurance forms and other paperwork and unwieldy federal regulations. Today, less than one in five doctors are solo practitioners, according to the American College of Physicians. Instead, large groups, hospitalists, and physician extenders are the front line of medicine. Even the title, "doctor" is morphing into the generic "provider." Commercialization of health care is evident with billboards advertising everything from cardiac surgery to treatment for urinary disorders.

The elder physicians can provide insights about a profession that now markets itself in the same vein as the fashion and food industries. But their advice could focus on more than just clinical practice. The Institute of Medicine reported in 2009 that 18,000 deaths per year are attributable to lack of insurance. With a reported 50 million Americans uninsured according to the United States Census, the Affordable Care Act promises a 50% reduction. Physicians with decades of experience clearly have a perspective on government intervention -- both good and bad -- in health care delivery.

For example, the government implemented the Surgeon General's warning on cigarette boxes in 1971 at a time when physicians were championing President Nixon's fight against cancer. There must be useful knowledge regarding preventive health that doctors of that era could share as it relates to the present government efforts to combat childhood obesity.

Similarly, our medical education system would profit from some historical viewpoints. The American Association of Medical Colleges estimates that nearly 16,000 newly minted doctors will enter residency training this year. Unlike their mentors who generally acted more like Dr. Welby, they have been educated in a curriculum that tackles medical mysteries with a technological bend -- like Dr. House. Diagnoses once made through history and physical examination, then confirmed by laboratory tests, has been turned upside down. Our nation's teaching hospitals rely on $9 billion per year of Medicare funding which remains in jeopardy. How best to educate and fund new doctors joining the profession requires insight from those soon to retire.

The time has come to assemble doctors who practiced the art during an era with the greatest changes in the history of medicine -- from the discovery of antibiotics to routine open-heart surgery and organ transplantation today. Their reflections on the past can help us with solutions to better health care. The White House and Congress should announce a meeting of the old guard to hear their collective views on timely topics. We all will be beneficiaries if our leaders carefully consider their wisdom as America crafts a 21st century health care system. It may just be what the patient ordered on this Doctors' Day.

Howard Zucker, MD, JD is a pediatric cardiac anesthesiologist at Albert Einstein College of Medicine in the Bronx, New York and former Deputy Assistant Secretary of Health and former Assistant Director-General of the World Health Organization.