A Very Good Read

"One Doctor - Close Calls, Cold Cases and the Mysteries of Medicine" by Brendan Reilly, M.D.   Atria Books    448 pages    $28

First of all, I am a total sucker for medicine - tales of internships; vile diseases; clever ways people were cured - and what was wrong with them in the first place.  Reilly doesn't disappoint.

Moreover, he knows the differences between Medicine Then and Medicine Today which is more business driven than delivery of care.

There is a much withdrawal of medical help as there is of giving it.  There are people pouring into Emergency Rooms all over America every day.  Let's say you are a doctor and a hugely critical case comes roaring across the ER - the patient needs to be in ICU NOW! 

But:  ICU is full.  What now?  This is what - the least sickest patient in ICU is moved to a Step Down room and a bed is freed for the new guy.  The space in ICU -- or in hospitals for that matter - is tight, forcing patients to wait their turn for a room in corridors, cubbyholes or halls. 

Reilly is a passionate advocate for one person to have one doctor for years.  He believes that personal knowledge of a patient through years of association is a critical factor for the doctor..  Medical care today is often a network of specialists.  The chain of command is:  you go to your General Practitioner (GP) who examines you and then says, "I want you to see an orthopod/neurologist/ENT"  and away you go to a stranger's waiting room.  In this system, the only doctor you're going to know is the GP who is good for small fixes, but otherwise acts as a medical traffic director.  

Plan ahead - get set with specialists before the GP can "assign" you one.  Before I married Richie and moved to the beach, I lived in Beverly Hills (poverty is possible there; I can assure you) and there was no such thing as a GP anywhere around.  Ear ache? Sore throat?  You called the ENT. Beverly Hills was so over-run with specialists that no body part was  ignored.  Used to this, I never put all of my eggs in one basket - the GP - when I began living here.  As a consequence, no matter where the GP wants to send me, I've probably already got a relationship with that specialist. 

To really terrify yourself, read this book to see what business-driven medicine can do to you.  It often isn't pretty....