Monday, March 25, 2013

Ayn Rand Meets Medical Practice

Alexandre Yersin

Consider Dr. X, an acquaintance, I cannot say a friend, of mine. He is a very bright man, and hard working. A graduate of Princeton, he chose his specialty with calculation and he studied diligently for his board examinations and he did his fellowship in gastroenterology and he focused with great determination on learning the colonoscopy and endoscopy procedures. For several decades he aggressively sought patients on whom he could do his endoscopic procedures, which were, for years, paid inappropriately generously by both Medicare and insurance companies. 

But in recent years, Medicare has finally awakened to the fact that colonoscopies can be learned by almost anyone, with or without a medical degree, and can be safely performed in less than 40 minutes. The $2500 fee is going the way of the dodo and seeing the changes approaching, Dr. X decided it was time to bail out of direct patient care and he has shifted his practice in a new direction: He now makes $850 and hour testifying as an expert witness at malpractice trials.  

And he testifies not just about cases of alleged malpractice in the world of gastroenterology--the law does not require you be a specialist in the specialty relevant to the case before the jury. You can be a gastroenterologist and testify about a case of heart surgery, and base your testimony on "experience from years of practice."

So, for years Dr. X exploited a flaw in the medical system which allowed for very high payments for a mundane procedure; and now he is exploiting the medical/legal system and its irrationality and unsophistication,  as judges, who are lawyers, try to fathom the claims and counterclaims, accusations and defenses, concerning cases about which the judges and juries are hopelessly incompetent to judge. 

In the process, he has prospered, put his own children through Princeton, driven luxury cars, lived in large houses, vacationed in lovely lands. 

He has violated no laws, and he is a man for whom waiters reserve the best tables, about whom clergymen speak well for his contributions to the congregation.

And yet this man has raped the system, both medical and legal.

Ayn Rand would consider  him a hero. 

He testifies at trials of doctors who have done nothing more wrong than agreeing to care of patients in dire straights, who were likely to meet an unfortunate end, the classic "bad outcome" patients,  doctors who got sued for their efforts.  Dr. X is willing to show up in court for the plantiff,  to testify that these doctors were insufficiently attentive or simply made the wrong choices for their patients.  

Dr. X would say he has nothing personal against these doctors he testifies against; it's just business.

He has no trouble sleeping at night, because, he would tell you, it's not his fault if a hard working doctor who tried his best for a patient loses the malpractice case. It's just the way the system works.  Dr. X is simply taking advantage of the money which is being laid out there for the taking.

He has found his niche.

Then consider Alexandre Yersin, who was offered a plum position by none other than Louis Pasteur, at the Pasteur Institute, but Yersin chose instead to live in Indochina, now Vietnam, to treat the locals and to experiment with importing and cultivating rubber trees, providing a local industry for generations to come. And when black plague broke out in nearby Hong Kong, Yersin set off to find its microbiological cause, and he put himself at risk doing this, and he was successful and he raised anti serum to the plague and he became the first physician to successfully treat plague and to save patients from plague, all in the late 19th century, early 20th, before the age of antibiotics.

As we look to being hard headed about the "business of medicine," and as we hand over the design of our medical systems to men with MBA degrees, to accountants and managers, might we not consider the imperatives which govern the practice  of medicine and what makes medicine different from business, from selling insurance or automobiles or cell phones?

Ayn Rand would extol the virtues of the dispassionate Dr. X, and she might dismiss the value of Dr. Yersin as a man who never started a really lucrative business, who never exploited the commercial potential of cultivating rubber trees in Vietnam.

One might ask: which man would you like your son to grow up to be?

The Phantom never asks questions like that. The answer seems too obvious.
But, then again, in Ayn Rand terms, the Phantom is a loser.


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