Henrietta Hay's Column

The art of healing is as old as humankind, but in the waning days of the 20th century it is in danger. In our highly complicated society the practice of medicine is on the verge of being taken over by business, politics and the insurance companies. This makes a lot of doctors unhappy and it makes their patients very nervous.

I grew up thinking that The Doctor was one step down from God. My grandfather was a physician and I never heard my grandmother refer to him as anything other than The Doctor. In fact, I don't think I knew until I was grown that his name was John.

He used a horse and buggy for transportation as he visited his patients in the farm country of central Illinois. By the time I knew him he had moved up to automobiles, but the image in my head is of this kindly man in his buggy with his black bag on the seat beside him, bringing comfort and hope and sometimes life to those who were awaiting him anxiously.

Healing in one form or another has been practiced since the day of the cave man. Throughout the ages the shaman, the medicine man, the early physicians, and finally the modern doctor discovered ways to cure the sick, sometimes with magic and charms, eventually with the help of science. Hippocrates in 460 BC, laid down rational medical principles still followed by physicians today, but as recently as the 18th century a British physician learned about digitalis from an English witch. Morphine, quinine and ephedrine come from ancient pre-scientific lore. According to the Grolier Encyclopedia "Throughout recorded history, the rational and the magical approaches have existed side by side."

The scientific explosion in the 20th century has brought medical miracles. But the social and ethical principles needed to take advantage of that knowledge are lagging far behind. We don't know how to distribute medical care effectively, or how to pay for it. Quality issues are meeting economic issues. Managed care, socialized medicine, drive-through surgery -- the tremendous financial and political pressures on the medical profession are forcing changes. We all understand that. But they don't make me very cheerful about the future.

I have always been very smart or very lucky. All my life I have had good doctors and good care. At this point in my life I would rather not have some corporation telling me who I can have for a doctor, or making the rules as to how the doctor can treat me.

I recently had my first experience with an electronic focus group. We were answering questions about what we want in health care. The interactive use of computers fascinated me, but I managed to wrest my attention away from the mechanics and pay some attention to the questions. To me the two really important ones were: "Do you consider your physician to be competent?" And "Does your physician show genuine concern for you as a person?"

I think it says something about modern health care that such questions need to be asked. But there were others far scarier. Many had to do with services, cost, convenience, staff -- non-medical things which apparently the "customers" and competition are forcing the doctors to spend time on. A couple of the questions got right down to the nitty gritty. Would you change to another practice if your insurance company told you that the charge for an office visit would be $15 less? Or would you change if your insurance company said your premium would be 20% lower per month, but that you would have to change to physicians in another practice. My answer was no.

Hippocrates, wherever he is, is shaking his fist at us.

Somehow - and I only ask the question; I don't have to answer it -- Congress and the states must solve the national health problem without taking away the thing that we treasure in our doctors. The physician must be able to treat his/her patients the way my granddad did a hundred years ago -- as whole human beings, as friends, but with all the knowledge and skill that the years have brought. If we can put a man on the moon surely we can afford that.