Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Physician-at-large Robert B. Howard To cite this article: Robert B. Howard (1976) Physician-at-large, Postgraduate Medicine, 59:4, 63-65, DOI: 10.1080/00325481.1976.11714322 To link to this article: http://dx.doi.org/10.1080/00325481.1976.11714322
Published online: 07 Jul 2016.
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Date: 16 August 2017, At: 09:19
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physician-at-large
THE MEDICAL CARE COST DILEMMA
Robert B. Howard, MD Consulting Editor
Newspapers and general circulation magazines today regularly feature articles about medicine, especially about the health care system and the sharply rising costs of medical care. Such articles serve a useful purpose in focusing attention on this area of mounting public concern. However, even when weil researched and weil written, they always seem to imply that physicians, acting out of ignorance, insensitivity, or greed, are more or less personally responsible for high medical care costs. If only physicians can be brought into line, either by the carrot or by the stick, the argument seems to go, the problem can be resolved. Seldom have 1read in the public press an accurate portrayal of the dilemma that faces the conscientious, competent, and honest physician. The dilemma stems from the tact that it is possible to practice various levels of medicine. While these levels actually representa continuous spectrum, for the purposes of this discussion they are regarded as four distinct entities and are called Cadillac medicine, Chevrolet medicine, Volkswagen medicine, and Motorscooter medicine. If we apply this concept to a clinical problem, Motorscooter medicine woukl be represented by prescribing aspirin or a comparable drug in response to a patient's complaint of headache. Volkswagen medicine would involve a modest inquiry into details of the complaint and a cursory neurologie examination. The same prescription for aspirin would probably follow. Chevrolet medicine would involve a complete history and a physical examination that included a complete neurologie examination supplemented by skull x-ray films. Cadillac medicine would include ali of the features of Chevrolet medicine as weil as such highly sophisticated studies as radionuclide scanning ahd computerized axial tomography (CAT scan). The tact that Cadillac medicine costs a good deal more than Motorscooter medicine should come as no surprise. Most physicians practice medicine at ali of these levels on various occasions. We perhaps practice Motorscooter medicine most frequently on ourselves and on members of our family . ..,. Note: The thoughts expressed in this article were, in large measure, published on the editorial page of the Minneapolis Tribune, December 26, 1975, in a latter commenting on a series of articles ("The High Cost of Health," by Joe Rigert and Lewis Cope) that appeared in the same newspaper November 9 through 16, 1975.
Vol. 59
o
No. 4
o
April 1976
o
POSTGRADUATE MEDICINE
63
. . - p h y s i c i a n - a t - l a r g e - - - - - - - - - - - - - - - - - - - - -....
Downloaded by [Australian Catholic University] at 09:19 16 August 2017
The physician's real dilemma comes in attempting to select the proper level of medical practice to apply to a given patient. Here we frequently find ourselves in a "no win" situation. If we carry out the Cadillac workup and ali findings are essentially normal, we are considered responsible for needlessly increasing the cost of medical care. If, on the other hand, we apply the Volkswagen or even the Chevrolet approach in an instance when only the Cadillac approach would reveal the presence of a serious and treatable disorder, we are considered incompetent. lndeed, as the current malpractice situation shows, we may be held legally accountable. Given these circumstances, it is not surprising that most of us lean toward the Cadillac approach. 1believe that most individuals, when sick, desire cautious Cadillac medicine. However, when healthy and acting as members of a corporate society, they become concerned about the cost of Cadillac medicine and reach out for the Motorscooter solutions for society in general. The problem is further compounded by the tact that advances in medical science and technology rather quickly transform what is today's Cadillac medicine into tomorrow's Chevrolet medicine. When presented with a situation in which the lite of a child may possibly be saved by intensive and extremely costly medical efforts, what parent, hospital administrator, physician, or government official can say, "Let us settle for the Motorscooter approach; we cannot afford the Cadillac"?
COMINGIN-----------------------------------------------,
medical practice toda y Preventing Pulmonary Embolism With Heparin in Low Doses
Reversing Secondary Metabolic Encephalopathy
Sol Sherry, MD Temple University School of Medicine, Philadelphia
Joel R. Saper, MD University of Michigan Medical Center, Ann Arbor
Fibroadenoma of the Female Breast: Some Epidemiologie Surprises Dennis M. Nigro, MD Claude H. Organ, Jr., MD Creighton University School of Medicine, Omaha
Vol. 59 o No. 4 o April1976 o POSTGRADUATE MEDICINE
A Critical Appraisal of IPPB John B. Fouts, MD RichardE. Brashear, MD Indiana University School of Medicine, Indianapolis
65
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Physician-at-large Robert B. Howard To cite this article: Robert B. Howard (1976) Physician-at-large, Postgraduate Medicine, 59:4, 63-65, DOI: 10.1080/00325481.1976.11714322 To link to this article: http://dx.doi.org/10.1080/00325481.1976.11714322
Published online: 07 Jul 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Australian Catholic University]
Date: 16 August 2017, At: 09:19
Downloaded by [Australian Catholic University] at 09:19 16 August 2017
physician-at-large
THE MEDICAL CARE COST DILEMMA
Robert B. Howard, MD Consulting Editor
Newspapers and general circulation magazines today regularly feature articles about medicine, especially about the health care system and the sharply rising costs of medical care. Such articles serve a useful purpose in focusing attention on this area of mounting public concern. However, even when weil researched and weil written, they always seem to imply that physicians, acting out of ignorance, insensitivity, or greed, are more or less personally responsible for high medical care costs. If only physicians can be brought into line, either by the carrot or by the stick, the argument seems to go, the problem can be resolved. Seldom have 1read in the public press an accurate portrayal of the dilemma that faces the conscientious, competent, and honest physician. The dilemma stems from the tact that it is possible to practice various levels of medicine. While these levels actually representa continuous spectrum, for the purposes of this discussion they are regarded as four distinct entities and are called Cadillac medicine, Chevrolet medicine, Volkswagen medicine, and Motorscooter medicine. If we apply this concept to a clinical problem, Motorscooter medicine woukl be represented by prescribing aspirin or a comparable drug in response to a patient's complaint of headache. Volkswagen medicine would involve a modest inquiry into details of the complaint and a cursory neurologie examination. The same prescription for aspirin would probably follow. Chevrolet medicine would involve a complete history and a physical examination that included a complete neurologie examination supplemented by skull x-ray films. Cadillac medicine would include ali of the features of Chevrolet medicine as weil as such highly sophisticated studies as radionuclide scanning ahd computerized axial tomography (CAT scan). The tact that Cadillac medicine costs a good deal more than Motorscooter medicine should come as no surprise. Most physicians practice medicine at ali of these levels on various occasions. We perhaps practice Motorscooter medicine most frequently on ourselves and on members of our family . ..,. Note: The thoughts expressed in this article were, in large measure, published on the editorial page of the Minneapolis Tribune, December 26, 1975, in a latter commenting on a series of articles ("The High Cost of Health," by Joe Rigert and Lewis Cope) that appeared in the same newspaper November 9 through 16, 1975.
Vol. 59
o
No. 4
o
April 1976
o
POSTGRADUATE MEDICINE
63
. . - p h y s i c i a n - a t - l a r g e - - - - - - - - - - - - - - - - - - - - -....
Downloaded by [Australian Catholic University] at 09:19 16 August 2017
The physician's real dilemma comes in attempting to select the proper level of medical practice to apply to a given patient. Here we frequently find ourselves in a "no win" situation. If we carry out the Cadillac workup and ali findings are essentially normal, we are considered responsible for needlessly increasing the cost of medical care. If, on the other hand, we apply the Volkswagen or even the Chevrolet approach in an instance when only the Cadillac approach would reveal the presence of a serious and treatable disorder, we are considered incompetent. lndeed, as the current malpractice situation shows, we may be held legally accountable. Given these circumstances, it is not surprising that most of us lean toward the Cadillac approach. 1believe that most individuals, when sick, desire cautious Cadillac medicine. However, when healthy and acting as members of a corporate society, they become concerned about the cost of Cadillac medicine and reach out for the Motorscooter solutions for society in general. The problem is further compounded by the tact that advances in medical science and technology rather quickly transform what is today's Cadillac medicine into tomorrow's Chevrolet medicine. When presented with a situation in which the lite of a child may possibly be saved by intensive and extremely costly medical efforts, what parent, hospital administrator, physician, or government official can say, "Let us settle for the Motorscooter approach; we cannot afford the Cadillac"?
COMINGIN-----------------------------------------------,
medical practice toda y Preventing Pulmonary Embolism With Heparin in Low Doses
Reversing Secondary Metabolic Encephalopathy
Sol Sherry, MD Temple University School of Medicine, Philadelphia
Joel R. Saper, MD University of Michigan Medical Center, Ann Arbor
Fibroadenoma of the Female Breast: Some Epidemiologie Surprises Dennis M. Nigro, MD Claude H. Organ, Jr., MD Creighton University School of Medicine, Omaha
Vol. 59 o No. 4 o April1976 o POSTGRADUATE MEDICINE
A Critical Appraisal of IPPB John B. Fouts, MD RichardE. Brashear, MD Indiana University School of Medicine, Indianapolis
65
