The American Dilemma and How We Can Fix It

Posts tagged ‘bureaucracy’

ON MEDICAL ETHICS

My physician in Chicago, Dr. Sherman and I had a long-term relationship until his retirement.  He ran a practice in which he knew his patients and never seemed to be overly interested in expanding his business.  His staff consisted of one nurse – a woman who happened to be Mrs. Sherman.

When I called for an appointment, there was no menu to get through to reach the right party.  Either Dr. Sherman or his wife took the call.  I could hear them turning the pages of the appointment book to find a time that was good for both of us.

All his patients had his home telephone number in case of an emergency.  I used it one time in the thirty years I saw him when I had an extremely bad case of the flu.  Dr. Sherman decided that I needed to see him right away – so he made a house call.

Dr. Sherman treated adults and he treated children.  And most of all, he treated his patients with compassion and respect.  After an appointment he always took time to sit down with me to find out how my life was going.  These conversations inevitably concluded with the statement, “I hope I don’t see you until next year for your physical – unless it’s at the symphony.”  I knew he meant that.

Hippocrates would have been proud of Dr. Sherman and other professionals like him.

Are there any Dr. Shermans left today in the practice of medicine?  If so they are well camouflaged.  Today the practice has taken on all the characteristics of our technological age and incorporated some of the worst elements of factory farming as well.

The personal relationship between the physician and patient has been replaced by the more highly efficient bar code where the individual is simply numerically identified as one of the herd, milling about the overcrowded stall.

With the lack of interpersonal relationships between physician and patient, it is easy to see how the following situation might occur.

A 23 year-old  man in Philadelphia was denied a heart transplant.  Although he is a good candidate for the procedure, the reason he was declined was because he is autistic and has other psychiatric issues.  In making the determination to reject his application, reasons that were cited included the possibility of steroidal interference with his general health.  Steroids are necessary in order to maximize the patient’s ability to accept the new organ.

There are, perhaps, better candidates for a heart transplant than this young man.  And there is a shortage of hearts and other organs which are available for that purpose.  But it’s difficult to avoid wondering about the procedures and the people who will make these determinations for all of us should Obamacare survive and go into effect.

Under the Affordable Care Act, seven as yet unnamed bureaucrats will effectively be in charge of our dispensation of medicine.  If that doesn’t frighten you it should.  Simply look at how well bureaucracy has bungled most matters with which it has been entrusted.  It’s been that way since Joseph invented the concept in ancient Egypt.

What is most disturbing to me is that when you have an impersonal bureaucracy viewing the general public as merely components which make up a herd, it is not a difficult step to begin to decide that perhaps that herd should be culled and the weak sacrificed for “the greater good.”

With no personal relationship with the victims it’s not too hard to arrive at that view, if you think of them merely as statistics – a mindset not much different from that held by the mass shooters we hear so much about of late.

If you believe that could never happen in America you are wrong.  It has happened.  It was called the Tuskegee syphilis experiment  (also known as the Public Health Service syphilis study).  If you want more details on how 600 impoverished black sharecroppers went untreated for their disease so that we could analyze its progression, you will find it at this link to the Wikipedia article.

http://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment

It doesn’t take a particularly fertile imagination to question that if this one experiment has made its way to the light of exposure, are there others about which we have never heard?  And if so, how many and who are those who were victimized?

The greater good is a nice phrase.  But the good or ill that any society does must always be measured by the way it treats it’s least important member.

We must always be mindful that if we stand by silently as another group is selected as the sacrificial lambs, we have opened the door to a shift in attitude or policy and we may be the next group of sheep on the way to the slaughter house.  Both ethics and common sense suggest that we should oppose any such policy or program with all our might and strength.

Dr. Sherman passed away several years ago at the age of 87.  I suspect there are few left who are like him – physicians who have a true sense of compassion and a relationship with their patients.  People whose lives embodied the very essence of medical ethics.  Their passing is a great loss for all of us.

MY MORNING AT THE IRS

For once I decided to be proactive.  I was not going to wait for the booklet to arrive.  I was going to get the forms I needed to file my income tax return and get it done before midnight on April 14th.  I was on a mission.

As I prepared to leave the office I realized that I might be able to provide a benefit to my like-minded employees.  So I explained that I was headed to the IRS to pick up tax forms and would be happy to get any that my employees needed.  Several people spoke up and said that they would appreciate that.

When the list was compiled, there were 9 different forms (and Instruction Books) and a total of 37 copies that were required.  I headed out on a beautiful early March day to the IRS office at 230 S. Dearborn Street in Chicago.

When I arrived at the IRS’ lobby a large sign said that forms were available on the 17th floor.  I went to the elevator, my list in my pocket.

When I exited the elevator – another large sign had an arrow directing me to the room where the forms were available.  I followed the arrow and went into the room.

Much to my surprise and delight, other than the two IRS employees who were behind the counter – I was the only person there.

I proceeded to the counter and pulled the list out of my pocket.  I waited patiently as the two employees discussed their dates and their weekend.  I waited patiently and politely at the counter – figuring that they would eventually deign to assist me.

After five minutes, the female IRS employee came over to the counter and said, “Can I hep you?”

I said, “Yes, please.  I would like to get the forms and instruction booklets I’ve written on this list.”  I  handed her the list.

“Do you has a number?”

“A number?,” I asked.

“Yes.  I can’t hep you unless you has a number.”  She pointed to the entrance of the room where by the side of the door I saw a rack of hard plastic numbers hanging on the wall– the kind you used to see in a butcher shop or bakery.

I said, “No, I don’t have a number but I’ll go get one.”

I came back with a number (01) and when I returned to the counter this woman looked at me as though I were new to the room.

“Do you has a number?”

“I do”.

She looked at the rack of numbers and called, “Number 01”.  I handed her my number and my list.

She turned from me, took perhaps three steps and then returned to the counter.

She said, “I can’t fill this order.”

Thinking that the forms had not been printed I said, “When do you expect to get the forms in your office.”

She said, “We got the forms.  But you only allowed to get five different forms and a total of 25 copies on one day.”

In a perverse way this made sense to me.  I could see how it would be inconvenient if a person came in to get a large number of forms – thus holding up everyone else.  But since I was the only customer I was willing to have her fill the first 25 forms on the list and then “wait in line” to take my turn for the rest.

Realizing that I was not dealing with an Einstein here, I said, “Well, if you would be kind enough to fill the order for the first 25 forms, then I will go back in line, take another number and wait my turn.  Then I presume it would be okay for you to get the remaining 12, right?”

“No.  You kin only get 25 forms per day.”

At this point my usual gentility was starting to fade – dramatically.  So I said, “What if you fill the first 25 forms on my list.  I then go back to my office and ask my 71 year old secretary to walk a mile and a half and hand you the list to get the remaining forms.  Would you give them to her?”

“Yep.”

“Now don’t you think that’s a little silly?,” I asked.

I don’t know if I struck a chord with her over my 71 year old secretary or what it was that motivated this woman, but without answering me, she turned away with my list and about 10 minutes later returned with my complete order.

Plus I got a bonus.  In addition to all the forms that I had requested she provided three additional ones.  They were entitled, “FORMS TO REQUEST FORMS.”

I used to be critical of Treasury Secretary Tim Geithner’s failure to pay his own taxes.  I mean, after all, he is the head of the Federal agency that has the IRS within his domain.

But as I thought back on this situation I realized that Sec. Geithner is probably as pure as the driven snow and the reason he failed to properly complete his return was that HE COULDN’T GET THE FORMS!

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