As a junior at Amherst, I often wandered into organic chemistry five minutes late, my slippers covered with snow and my hot chocolate dripping. It was February of 1962 and organic chemistry was an obligatory pre-med course. But it was more of an IQ wall than a key to becoming a good doctor.
We must always be careful what we wall in and wall out. These days a high EQ (Ethics Quota) might save more patient lives than a high IQ.
My memories of Amherst were stirred last December when I received the Amherst College Newsgram, a sort of alumni Who's Who in the corridors of power, finance and the arts. Amazed, I discovered that Dr. David Lawrence '62, CEO of the "not-for-profit" health organization Kaiser Permanente, was featured. I was probably a freshman when he trudged to the same organic chemistry pre-med class as a junior.
We shared a campus. Now, however, we are divided by legally combative positions. In fact, I am the medical expert in a suit that is asking Kaiser to give back perhaps $200 million in allegedly ill-gotten and unsafe gains from the practice of forcing pill splitting on the infirm. I will also be an expert witness to Kaiser's underreading of a cardiac stress test which, if overlooked, can lead to sudden death from gastritis.
Dr. Lawrence would turn the nation toward the great cause of front line medical error-a hyped cause financed by managed care-overemphasizing the number and severity of mistakes made by doctors while insinuating that managed care organizations can help to allay such error. I would like, instead, to expose the killing fields of managed care in which organizational disasters are routed into a profession sped up in time and compromised in purpose by the same framework that purports the opposite.
For the moment, Lawrence, along with the former head of the Veterans Administration medical system, has been able to divert Congress away from the path of patient rights due to the spotlight of such "medical error."
But the real center of Medical Error-in which every pre-med student is at risk of being consumed-is the diplomatic protection afforded to managed care back in the 1970s, allowing them to damage patients and control staff with impunity. The HMO Act, followed by Employee Retirement Income Security Act (ERISA) protections, simply created Death Stars of deception immune from something as basic as legal recourse. Patient Rights could only be missing if Congress first took them away in the past through ERISA legislation!
I am sad that the Amherst College Newsgram echoes Dr. Lawrence's supposed fascination with medical error. It only increases the chances that those pre-med students now struggling with organic chemistry are wasting their time pursuing the illusion that they can emerge some nine years later with an option to freely practice what they have so diligently learned. Instead, they will be seduced by entities like the for-profit arm of Kaiser-the Permanente Medical Group-to join up to settle massive educational debts and, in the process, sell their souls.
I, however, lean heavily on my Amherst education to help organize the rebel forces who have preserved the soul of medicine in distant and hidden locations (mostly rural America). Although up against the organization of health plans-three times the size and with lobby funds greater than those of the tobacco industry-we shall plumb their core reactors and decimate their power.
And while the voting public was confused at the presidential level this year, they were not confused at the patient rights level. With the recent elections, the Senate votes necessary to achieve patient rights are now there. The year 2001 will be the point in history when the HMO industry will finally be held accountable to the people. No longer will patient care simply be a "loss ratio" to profit. The corridors of power will be opened, and the common patient will finally be able to walk with dignity.
Charles Phillips '64, MD, FACEP<br>Former Senior Class Orator