By Mark David Blum, Esq.
I would like to introduce everybody to my drug pusher. His name is Eugene Bailey. His offices are in Syracuse and the sole role he played in my life until today was as my drug pusher. Bailey has an “MD” after his name and though he never sets foot inside a hospital or deals with any medical issues above diaper rash, he has that MD and that makes him my drug pusher. He and the rest of us can thank the legislators who long ago passed the Harrison Act which empowered MDs with the foresight and sole authority to dole out drugs. What was once a consultation between peers, now turns Americans into begging sheep, at the mercy of butchers and selfish petty people. Please Dr. can I have my medications. Please Mommy, can I have some dessert.
Then there is the hospitalist. This is the physician who being one of many is in the direct or indirect employ of the hospital. As a hospitalist, the doctor not only hands out pretty little pills, but is actually involved in diagnosis, testing, consultation, and treatment. Generally, the hospitalist has no patients of his/her own but for those who are on the floor or needing an evaluation.
Unlike the hospitalist, my former drug pusher refuses to set foot in a hospital. Whether it is his fear of patients with real medical issues or his effort to minimize his workload, in my three hospitalizations, I never once saw my drug pusher Bailey even stop in. To the best of my knowledge, he never reviewed any of the tests and lived and died on the two sentence summaries sent him by the hospitalists and specialists in the hospital.
My last hospitalization started with me being in severe pain and showing up at my pusher’s offices only to have him yell at my Mrs., “what did you bring him here for?” She was so angry at him making this statement twice, that she immediately fired him and never went back. My pusher was far from prepared to handle even the most basic of crises or emergencies. According to Bailey the Pusher (when he isn’t whining about how little he earns as an Upstate doctor), he does not stock any medications or first aid in his office. He insists that anything requiring even a modicum of serious treatment be sent to a local emergency room; so the case can be passed onto the hospitalist. When I leave the hospital, my pusher just takes the drug orders from the real doctor and gives me a month or two supply so as to make me come back to beg for a refill and so he can charge my insurance company again. On my last visit, I had to ask my drug pusher to take my blood pressure since his nurses did not. He let a medical student attempt to do so and with some help from me, she got it done. It was probably her first breathing patient she had ever so performed.
Hospitals are a kit. In general, that kit includes everything from wheel chairs to chairmen of the Board. Among the contents of a hospital kit are certain doctors who align themselves with the hospital for “privileges” as well as those physicians who are on the hospital payroll and not running a practice of their own. Unlike Bailey the Pill Pusher, Hospitalists are the ones who make the effort to check in and out of every orifice to find the cause of the problem. It was an hospitalist that I met every visit and who diagnosed my illness and recommended a course of treatment. I was sent home with a small supply of meds and scheduled to see my pusher in a week. Doing nothing but repeating the findings of the hospital but still not having diagnosed my ailment, my drug pushing MD just refilled my prescriptions and sent me on my merry way.
This has to stop.
Over time, I have come to admire the hospitalist as being a true person of medicine. This is the physician on the front lines who without benefit of patient history or relationship, manages to evaluate the medical data and it is the hospitalist who sits with you at the end of the day with the news of the diagnosis and course of treatment. Every hospitalist I have met earned my respect and proved themselves as being the ones interested in serving the Hippocratic oath. Hospitalists end the harm, stop the pain, and fix the problem. It is the hospitalist who will be there when you come out of your coma, emerge from surgery, or need medical help.
Hospitalists are the MDs in the trenches. They are employed by the hospital and are not building a private practice. This starves them from their drug pushing colleagues. No patient base is no retirement. The need for hospitalists is driven by the fact that primary care physicians like Bailey just refuse to step foot in a hospital. This creates a monster we know as being a whole new layer of healthcare providers. If I call my doctor and tell him I have severe chest pains and am en route to a local E.R., standing next to the Hospitalist E.R. Specialist should be my doctor taking turns pounding on my chest. As a lawyer, I cannot take a client's money, draft and file a lawsuit, but on the day of trial, send the client off alone to the court house and say good luck -- hope you find a good lawyer. Be sure and come see me after to let me know what happens and so I can bill you again.
Seriously, in times of dire need, where will your pill pusher be? If your personal physician is like my now former physician, he will be sitting on his ever widening butt handing out crèmes and renewing prescriptions. If you are lucky, he may even find the time to inquire how you are feeling. A doctor who does not visit his own patients in the hospital is lazy and unfit to wear an MD. It should be my personal physician and not the hospitalist sitting on the edge of my bed at the end of the day telling me what is the diagnosis, prognosis, and course of treatment. As much as I trust the hospitalist because that doctor is closer to the situation on a daily basis, in my heart the only doctor with whom I had any relationship was my pusher. He is just too cowardly and lazy to come and visit his patients, take basic steps to alleviate their pain, or provide a level of safe and professional care. Most importantly, he never set foot in the hospital and I had to rely on the opinions of passing doctors; most of whom I never met but who were the hospitalists assuring my care. I cannot count the number of times someone would come into my room, check my ID bracelet and say, “you’re a patient of Dr. So and So.” I would respond, “I am not and I don’t know who he is. My doctor is (now was) Eugene Bailey.” They laughed knowing he would never show up to visit or treat his patient.
When we discuss changes in our delivery of medical services, one fundamental change should be that if you are going to have a State license to practice medicine and you are going to accept patients, they you have to remain their primary care physician throughout their entire medical history. At times specialists may be needed, but it is the primary care physician with whom the patient established a relationship and trusts. Any hospital that grants privileges should mandate that all treating physicians appear and spend time with hospitalized patients. It is very difficult to trust strangers and their opinions. This hole must be filled as otherwise, primary care doctors like Bailey relegate themselves to nothing more than insurance referral services and drug pushers.
I have it also upon reliable information and belief that my former drug pusher is also a lecturer at the SUNY Medical College. I know he shows a tape of a trial of mine as part of his class to teach a lesson. But this ‘teacher’ should not be allowed into a classroom or near a student until such a time as he learns what is most important to him professionally: Treat the patient in front of you, treat them as human beings, and be there for all their medical questions. My pusher was none of that and instead wanted to debate how little money he earns.
It is a shame that medicine is becoming so specialized that we “civilians” are no longer entitled to the benefit of having a family doctor. If that doctor is Eugene Bailey, then you as the patient can consider him to be as impersonal as a colonoscopy. He cares more about his workload and his income than he does his patients. For that reason he says, he refuses to visit his sick in the hospital. That is a shame and ranks him at the bottom of what is considered to be a caregiver.
I hate the fact that I have to trust my life and fate in the hands of a stranger. Getting the drugs is not going to be a problem as there are plenty of pushers out there carrying MD licenses. What I need is a real doctor; one who is “on” both in his offices and in the hospital. Even my career calls upon me at times to be away from home for more hours than I desire and in court or visiting in jail when I would rather be in the warm bosom of my family. But I recognize my obligation. Medicine as an industry really needs to re-think its’ obligations.
Next up: Hospital Kits