Former JAMA Editor Discusses State of Medicine
In his new book "Severed Trust: Why American Medicine Hasn't Been Fixed," former editor of the Journal of the American Medical Association Dr. George Lundberg writes about changes in the medical profession he has observed since entering the field in the 1950s. Lundberg writes that "business has taken over medicine" and that the "once-trusting relationship between doctor and patient has collapsed." In an interview in today's Los Angeles Times Health section, Lundberg, now editor in chief of the medical web site Medscape, addresses some of his concerns.
- Asked about the state of managed care, Lundberg says: "Managed care is basically over. People hate it, and it's no longer controlling costs. Health-care inflation is now back in the double digits. So if it's not saving money, then why should we have it? But like an unembalmed corpse decomposing, dismantling managed care is going to be very messy and very smelly, and take awhile." He adds: "In the future, I think we'll see some form of government health insurance, along the Medicare model. Not necessarily socialized medicine but one large insurance pool or one single payer where people and employers can buy in. I think we should have some kind of mandated health insurance, where every American has to buy a policy with a high deductible, and the individual has to pay above a certain point. People won't spend their own money unless it's justified. It's the only way we can control costs."
- Defending his statement that the AMA has "lost its credibility," Lundberg says: "Right now, only 27% of American physicians are members, which means nearly three-fourths of doctors have voted with their feet. The reasons why this has happened are complicated. But primarily, it's because business has taken over medicine. The AMA was so busy fighting the government it didn't understand business was an even bigger enemy, and it just rolled over. Physicians need to take their profession back from business and start behaving like professionals and put patients first again without question."
- On his charge that "physicians [have] neglected to provide reasonable care for ... patients," Lundberg says: "Patients feeling like they're cared for is probably more important than the scientifically correct treatment being given. For most people, the disease they have usually heals in time, so their concerns are mostly about their symptoms. Consequently, their attitude toward themselves and their caregiver can have a lot to do with how they handle their symptoms and even how quickly they get well." He adds: "[W]e still don't have cures or even treatments for many serious diseases that do any good. The way people live with their heart disease or with their cancer can greatly affect their quality of life and, in some instances, the length of their life. And the relationship of caring goes a long way toward influencing people to live with their disease well."
- Lundberg is also a "proponent" of using the Internet to practice medicine. He says: "[I]t opens up great possibilities to rescue the doctor-patient relationship. As the use of electronic e-mail medicine becomes ubiquitous, it will permit one doctor and one patient to get back together to do the right thing -- and bypass the insurance industry, managed care and all those allied health people that stand in between the doctor and patient today." He adds: "Of course, there are some things where a doctor simply must put physical hands on, or use a stethoscope or look into the eye of a patient. But there are many other times where none of that has to happen, and electronic dialogues will get to the nub of the matter very efficiently. You type in a request, the doctor responds -- it takes five minutes and the problem is resolved. In the future, if you have a biopsy, why would you want it read by an inexperienced person when it can be read by a doctor who knows most about the disease? And that's just one example. Eventually, the Internet will nudge us into handling medical licenses like driver's licenses -- a doctor will have a license in one state, but it will be good everywhere. It's ridiculous for a doctor in northern Arizona not to be able to practice medicine in Southern California, too"
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