The Deterioration Of Medical care in the USA

When I entered UC Berkeley in 1955 where was no major called pre-med; however, there were about 300 of us who had our hearts set on going to medical school and we all took the same classes. The majority of these classes were those that were prerequisites for medical school and had to be taken in proper sequence to make sure that the student would have completed them all by the end of their third year in college. As such all premed students took chemistry 1A in the fall of the first semester. Most chemistry majors deferred chemistry 1A until the spring semester. They did so to avoid having to compete with the premed students who were considered to be some of the brightest in the school. To make a long story short, it was very difficult to get into medical school in those days and, for the most part, only the brightest made the grade. However, despite the rigorous competition to get into a medical school in the 1950's and the intensive effort made by the medical schools to weed out those who were not qualified, two students in my 1963 class of sixty-four at the University of Southern California did not have the intelligence to be there. The point being, that even in the days before affirmative action, some students who did not have the intellect to become good doctors slipped through the cracks and became physicians despite the best efforts by admission committees to keep them out. The situation is much worse today because, with rare exception, the best and the brightest are not going into medicine. Rather, students who used to go into medicine are now becoming engineers and technology wizards. Why? Because the government run medicine of the twenty-first century is too controlling and doesn't pay enough. As I pointed out in my book So, You Want To Become a Medical Doctor it makes little sense to spend half of one's life while becoming hundreds of thousands of dollars debt to enter a low paying government run profession like medicine if you have the smarts to become wealthy in half the time by working for a company like Google, Macintosh or Apple to name only three of today's technological giants. Not only are the best and the brightest not going into medicine today but the medical schools, through their affirmative action programs, are encouraging those with marginal intelligence to become physicians. Napoleon Bonaparte once said that a picture is worth a thousand words. This may be, but the true story I'm about to relate will go a long ways towards explaining the adverse effects affirmative action programs have had in the doctors being graduated from today's medical schools. I first published this article on my blog The Conservative Pulpit in June of 1912. I tilted it: Low Pass: affirmative action at its worst and the end of medicine as I knew it! When I moved back to California in 1973, after 7 dreadful years in Minnesota (the weather not the people), I was on the Urology faculty in the Surgery Department at the University of California Davis. As a member of the surgery department, I participated in the oral examinations given to UCD’s third year medical students after completion of their surgery rotation. To put what I am going to relate to you in perspective, before the days of affirmative action, the weeding out of people who wanted to become doctors but were not qualified, occurred before they got into medical school. In other words, it was tough to get in, but once in you were accepted to medical school you almost sure to graduate and to pass the licensure examinations thereafter. This is not to say that the training and testing of medical students was anything but rigorous, to say the least. It was just that if you could get into medical school, you were able to handle most anything that the faculty could throw at you. This, as you may know, is the opposite of what happens in Law schools where almost anyone who can come up with the tuition can get into a law school somewhere and the weeding out process occurs during the first year and later at the bar examinations. Anyway, getting back to the event that I am about to relate, there were around 15 pairs of professors who were charged with examining the third year medical students at UCD; in my case, I was paired with a general surgeon, and we gave oral exams to about 6 to 8 individual students who were taking their oral examinations that morning. Each examination lasted about 15 minutes and each student was examined by 4 different pairs of examiners. Each of the students also had completed a multiple choice type of written test, although we did not know, by design, until later how they had faired on the written examination. To make a long story short, all of the students that my partner and I quizzed did reasonably well and we were not able to stump several of the them no matter how difficult we made the questions. That is all but one, a black female who didn’t seem to have a clue about anything we asked her. I recall specifically that she had no idea as to the significance of red blood cells in the urine and was clueless with respect to the difference between a direct and indirect inguinal hernia. We, of course, had no option but to flunk her. When the oral examinations were concluded and we all convened to determine the grades the students would receive, the other three pairs of faculty members who had examined this black medical student also came to the same conclusion we had. One examiner commented that he couldn’t believe that she had actually taken the surgery course, "Seemed impossible" were his exact words. Considering her lack of knowledge, it was no great surprise to learn that she had also failed the written examination. When it came time for the final vote, every single one of the 30 or so examiners, with little discussion, voted to flunk her. As it turned out, this was her second try at passing the surgery course. She had flunked the first time around and flunking again meant that she was out of medical school, which should have been a blessing for everyone concerned and especially for her future patients. What happened next took me completely by surprise. Understand that we did not have affirmative action in the University of Minnesota at that time and I, as a new member of the faculty at UCD, was unaware of the school liberal bent and totally unprepared for what was to happen next. In any case, the chief of surgery, Earl Wolfman (may he spend eternity roasting in the hottest part of hell), who had not said a word during the grading session up to this point, cleared his throat and said the two magic words that all low achievers want to hear, "Low pass". At that point, I knew that medicine, as I knew it, was a thing of the past. Those that make policy relating to medicine in the United States have been extremely successful in their efforts to conceal the changes that have been made medical care over the past 50 years. Where we live, in central Contra Costa county, recent renovations in the Walnut creek and Concord campuses of the John Muir hospital syste are expected to cost the John Muir Medical Foundation an estimated $800 million dollars. But, just how good is the medical care provided in these shinny new medical facilities? My wife was recently hospitalized in the new wing of the John Muir hospital in Concord. This was an eye opening experience for both of us and showed how much medicine has changed since I retired 13 years ago. My wife's surgeon was an extremely qualified laparoscopic surgeon of Asian descent who had gone to medical school in the orient before doing his surgery residency in a well known medical center on the East coast. To my amassment, her preoperative evaluation and post operative care was provided by physicians called hospitalists. Not a single one of these young doctors had gone to medical school in the United States, the majority of them were Indian females who had gone to medical school in India and had received most of their training there before immigrating to the United States. The hospitalists are hired by the John Muir Medical Foundation and have replaced the private practitioners who, in my day, were responsible for a patient's care when they were hospitalized. The question, of course, is just how well trained are these so-called hospitalists? Based on our experience, not too well. After spending about six hours in the emergency room, my wife was admitted to a surgical ward in a glittering new wing of the hospital. She was placed in a single bed room with a beautiful view of distant Mount Diablo. The hospital bed alone must have cost $20,000 the thing had every gadget imaginable and probably could do anything short of flying. My wife's Indian hospitalist ordered a battery of the usual blood and urine tests, an EKG and, most importantly, a flat plate of the abdomen. I knew that the x-ray of the abdomen would most likely confirm that she was experiencing another episode of intermittent bowel obstruction. This diagnosis seemed most likely since she had developed intermittent attacks of bowel obstruction on three occasions since undergoing an hysterectomy some 20 years before. The tests and flat plate (x-ray) of the abdomen were performed and the hospitalist returned to give us the results. To my surprise, she informed us that the x-ray of the abdomen was negative. Based on that finding she had concluded that my wife was suffering from some form of intestinal flu and that she was being transferred to a medical ward where her condition would be investigated further and treated appropriately. I was unprepared for such a diagnosis and was, momentarily, left speechless. When I finally came to my senses, I queried my wife about the abdominal x-ray, how was it performed? Apparently she had been wheeled into the room; transferred to the x-ray table lying on he back; and told to hold her breath while the x-ray was taken. I was stunned to learn how the x-ray was taken. Why, because the whole point of taking the flat plate of the abdomen was to determine if there were air-fluid levels in the intestines and one cannot detect air-fluid levels unless the patient is standing or lying on their side when the film is taken. At that point the mystery was solved and I knew, without a shadow of a doubt, that my tentiyive diagnosis of a small bowel obstruction had not been ruled out. I was about to leave the room and track down the hospitalist when a nurse entered the room to check on my wife's vital signs. I informed her about what had transpired and demanded that the abdominal flat plate be repeated, this time with my wife standing or on her side. To make a long story somewhat shorter than it actually was, we never saw the hospitalist again, she was replaced with another female hospitalist, again of Indian descent. Several hours later my wife underwent laparoscopic surgery to relieve a partial bowel obstruction brought on by adhesions that had formed after her hysterectomy twenty years before. Obviously, one cannot make a federal case on the basis one experience like this. However, it is impossible for me to believe that any third-year medical student attending an American medical school in the 1960's, or before, would not have known that a patent must be standing, or positioned on their side, when an abdominal x-ray is taken to rule out bowel obstruction. None of my classmates would have been so ignorant. So, how did it come about that Americans with serious medical conditions are being cared for in our major medical centers by doctors trained in faraway places like India? I think the answer to that question is obvious. Because of financial considerations, the best and the brightest American young people are not going into medicine today as they were in the days before the government took control of the medical profession. At this point in time, physicians, with a few notable exceptions such as neurosurgeons, invasive cardiologists and laparoscopic surgeons, are poorly paid servants of the bureaucracies that now control every aspect of medicine in this country. In former times doctors ran hospitals now administrators with no medical background what so ever determine every aspect of the medical care a person receives when he or she enters a hospital. Most persons untrained in the medical arts do not understand the significance of the changes that have occurred in medicine over the past century in the United States. When the average citizen enters a hospital today he leaves his personal physician behind and equates the palatial surroundings of the hospital with good medical care. In reality, the medical care they receive is provided, most often, by foreign trained females who hover over them like mothers and give the impression that they know what they are doing, while in reality, often times they do not have a clue. I have spent a fair amount of time on this subject because medical care related entities comprises one sixth of the American economy. As such, the passage and implementation of Obamacare was a gigantic blow to capitalism and the American way of life. I will not suggest a remedy for the situation in which we now find ourselves, in part 11, because I do not believe, at this point in time, there is one. Like it or not, we now have socialized medicine in this country and we are only one small step away from a one payer system similar to those of Canada, Great Britain and all of the other European socialized democracies. God help us!