Correspondence
First, Do No Harm (Pending Prior Approval)
N Engl J Med 1998; 338:1318-1320April 30, 1998
- Article
To the Editor:
At last, a physician willing to suggest that the American medical profession is a spineless, avaricious, and directionless cartel unworthy of being called caring (Nov. 27 issue).1 The fact that this sentiment had to be couched in irony of almost Brechtian density to be published in a respected journal heightens the effect.
I have often been asked whether I would like to work in the United States. “Hey man,” I'm told, “the money's really good.” I have always replied that I would rather sell my soul to the devil (he may be harsh but at least you know where you stand).
Your country, which spends 10 percent of its gross national product on “health care” and yet has one of the highest infant and perinatal mortality rates in the developed world, is so steeped in the specious “deserving poor” argument that the rest of the world can only gag in astonishment.
We poor Britons may seem financially strapped by exercising some social conscience, but as physicians we sleep well at night, knowing that our job is to treat the sick.
1 ReferencesDavid J. Brown, B.M., B.S.
Quarry Ln., Yateley GU46 6XW, United Kingdom1
Pruchnicki A . First, do no harm (pending prior approval). N Engl J Med 1997;337:1627-1628
Full Text | Web of Science | Medline
To the Editor:
Although I enjoyed reading the mythical interview of Dr. Hippocrates by the personnel director of a health maintenance organization (HMO), I was disappointed that Hippocrates was not more of an activist. He could have helped us all out by inviting the director, and HMO management in general, to try out a variation on an exercise that, in its original form, came from Greece — javelin catching.
Marvin Cohn, M.D.
Nashville Memorial Hospital, Madison, TN 37115Author/Editor Response
Dr. Pruchnicki replies:
To the Editor: I appreciate Dr. Brown's comments greatly. Unfortunately, I have some more bad news for him. We actually spend 14 percent of our gross national product on health care. He may have mistaken us for one of the relatively efficient systems of Western Europe or Canada that spend 10 percent. Or perhaps he could not actually believe that a nation that spends this much ($1 trillion) would still have significant gaps in access and quality. I also find it unbelievable, and sad. As far as Great Britain is concerned, no apologies for social conscience are necessary. Given that expenditures are 6 percent or so of gross national product, it would be able to cover every one of its residents twice and have money left over, if it spent as much on health care as we do. And yet Britain's National Health system is constantly being disparaged by our supposedly liberal press here in the United States.
Dr. Cohn's constructive suggestion of a game of javelin catching would be even more useful if we could engage some of our political leaders, whose narrow-minded, shortsighted, opportunistic, and ideological refusal to establish a national health system, as the rest of the industrial world has, helped to get us into this mess. Unfortunately, organized medicine is not entirely blameless in this regard either. As historian Paul Starr pointed out years ago, “The great irony is that the opposition of the doctors and hospitals to public control of public programs set in motion entrepreneurial forces that may end up depriving both private doctors and local voluntary hospitals of their traditional autonomy.”1
1 ReferencesAlec Pruchnicki, M.D.
Mt. Sinai Medical Center, New York, NY 10029
