Dr. Peter J. Weiss

My son gave me “The Auto­bi­og­ra­phy of Mark Twain” for Christ­mas and I’m slowly work­ing my way through the mas­sive book.

I’m read­ing slowly because his writ­ing is so enjoy­able but also because I’m really try­ing to absorb the cul­ture of an entirely dif­fer­ent era.  It’s fas­ci­nat­ing to have such a close look at daily life in the 1800’s given to us by a pop­u­lar and well-traveled man.

One of the most inter­est­ing aspects has been his descrip­tion of ill­nesses and med­ical care from the minor to the seri­ous.  I’ve been sad­dened by sto­ries of his friends and fam­ily mem­bers dying of dis­eases that would be eas­ily cur­able in today’s world.

As a for­mer infec­tious dis­ease spe­cial­ist, I am espe­cially moved by the deaths result­ing from pro­gres­sion of minor infec­tions.  We can all be very thank­ful for the progress we’ve made in the last 100 years in this regard.

Yet even back then, Samuel Clemens iden­ti­fied trou­ble­some changes in health­care that were just begin­ning.  He writes here about the change in physi­cian pay­ment sys­tem from a yearly retainer for the fam­ily (we would call it cap­i­ta­tion) to a per visit charge (fee-for-service):

Con­sider the wis­dom and right­eous­ness of that old-time cus­tom — the pay­ing of the physi­cian by the year.  Con­sider what a safe­guard it was, for both the physician’s liveli­hood and self-respect, and the family’s health.  The physi­cian had a reg­u­lar and assured income, and that was an advan­tage to him; the fam­ily were safe from his inva­sions when noth­ing was the mat­ter, and good­ness knows that was an advan­tage to the fam­ily.

Look at the dif­fer­ence in our day.  What is the com­mon, the uni­ver­sal, cus­tom of the physi­cian with lim­ited prac­tice?  It is this: to keep com­ing and com­ing, long after the patient has ceased to need him — and charg­ing for every visit.

This made me smile, and I knew I would have to share it with you.  It’s been over 100 years since Samuel Clemens wrote those words and we still have the same prob­lem.  Health­care providers are sell­ing health­care, but we want to buy (if we’re smart) is health.

The prob­lem is, as Mr. Clemens points out, that providers will sell you health­care that you don’t need, that may even be harm­ful.  Back then it was just an unnec­es­sary visit — an expense, but not a risk.

Today the over­selling of health­care is expen­sive and risky.  See these recent head­lines:

“Study Says Thou­sands Get Unneeded Heart Devices”

– New York Times 1/4/11

“HEALTH CARE: Drug Overuse”

– Rich­mond Times-Dispatch 12/6/10

“Health care providers pledge to stop radi­a­tion overuse”

– NECN

So what should we do?

We must think for our­selves.  We must be in charge of our health­care and our health.  I’m try­ing to show you how.  You can do it!