Meet Dr. John Raf­fensperger

Sani­bel physi­cian’s mem­oir, a pi­o­neer in chil­dren’s health

Times of the Islands - - De­part­ments -

John Raf­fensperger was a pe­di­a­tri­cian and teach­ing doctor. Re­tired and liv­ing on Sani­bel, he has re­leased The Ed­u­ca­tion of a Sur­geon, a mem­oir avail­able on­line and at lo­cal book­stores. Times of the Is­lands asked Raf­fensperger about to­day’s med­i­cal pro­fes­sion and his ca­reer.

TIMES OF THE IS­LANDS: YOU ARE HON­EST IN YOUR BOOK ABOUT MAK­ING MED­I­CAL MIS­TAKES.

JR: Ad­mit­ting, an­a­lyz­ing and learn­ing from med­i­cal er­rors are es­sen­tial to avoid re­peat­ing mis­takes. Hon­esty is nec­es­sary in the teach­ing of med­i­cal stu­dents and doc­tors in train­ing.

TOTI: THE PERCEPTION IS THAT HEALTH CARE IS DIC­TATED BY IN­SUR­ANCE AND THE HEALTH IN­DUS­TRY.

JR: Health in­sur­ance, started dur­ing the 1940s, was at first non­profit. The in­sur­ance com­pa­nies paid most of the hospi­tal bill and some com­pa­nies paid all or part of the doctor’s fee with no ques­tions. The in­sur­ance com­pa­nies did not in­trude on med­i­cal de­ci­sions. The in­sur­ance com­pa­nies be­came in­creas­ingly in­tru­sive when they went into “man­aged care” dur­ing the 1980s. The in­sur­ance com­pa­nies did their best to deny pay­ments. Pa­per­work be­came in­tol­er­a­ble and ex­penses mounted.

TOTI: MED­I­CAL SCHOOL WAS LESS COSTLY IN YOUR TIME.

JR: I at­tended a state school. My county schol­ar­ship paid the $90 [per se­mes­ter] tuition. Some of my fel­low stu­dents had the GI Bill and oth­ers worked to pay the bills. None of us went into debt. When the fed­eral gov­ern­ment com­menced dol­ing out grants for re­search, the uni­ver­si­ties, and es­pe­cially med­i­cal schools, de­vel­oped costly re­search fa­cil­i­ties that had lit­tle or noth­ing to do with teach­ing. Pro­fes­sors were judged by their abil­ity to ob­tain re­search grants rather than their teach­ing skills.

TOTI: YOU ARE CRIT­I­CAL OF MED­I­CAL CARE FOR THE POOR.

JR: This ques­tion goes to the heart of the prob­lems of med­i­cal care in our coun­try. With the ad­vent of Medi­care and Med­i­caid, care for the el­derly and the poor im­proved. Now, with the rise of com­mer­cial profit-ori­ented medicine, su­per spe­cial­iza­tion and frag­men­ta­tion, the qual­ity of care is de­creas­ing for ev­ery­one. Many community hos­pi­tals were orig­i­nally founded by re­li­gious or­ga­ni­za­tions to care for the sick, re­gard­less of their abil­ity to pay. When ad­min­is­tra­tors with an MBA took over, charity and com­pas­sion gave way to the bot­tom line.

Dur­ing the De­pres­sion of the 1930s, doc­tors con­tin­ued to see pa­tients, make house calls, de­liver ba­bies and per­form surgery

AD­MIT­TING, AN­A­LYZ­ING AND LEARN­ING FROM MED­I­CAL ER­RORS ARE ES­SEN­TIAL TO AVOID RE­PEAT­ING MIS­TAKES.”

—DR. JOHN RAF­FENSPERGER

re­gard­less of the pa­tient’s abil­ity to pay. Un­paid in­terns and vol­un­tary physi­cians looked af­ter thou­sands of the sick/poor in charity hos­pi­tals and at­tended free clin­ics in pri­vate hos­pi­tals. Many doc­tors who re­call their time spent at the Cook County Hospi­tal in Chicago dur­ing the De­pres­sion as their finest hours.

The post-war years saw a large in­flux of for­eign med­i­cal grad­u­ates who came here for fur­ther train­ing. They were sup­posed to return to their own coun­tries but many stayed be­cause of “in­creased op­por­tu­nity.” The in­creased op­por­tu­nity was not guided by a sense of mis­sion­ary zeal to care for Amer­ica’s poor, but a chance to make a great deal of money.

Po­lit­i­cal so­lu­tions have only made mat­ters worse. A cat­a­strophic break­down of the en­tire sys­tem or a physi­cians’ re­volt might bring about change. Sweep­ing reform must ensure health care for all, re­duce costs and re­store physi­cians to a cen­tral role in car­ing for the sick. Pol­i­tics have no place in health care. The best so­lu­tion is that rec­om­mended by the late Arnold Rel­man, that the mul­ti­ple in­sur­ance com­pa­nies and plans would be abol­ished and re­placed by a sin­gle-payer, not-for-profit, non­govern­men­tal in­sur­ance plan. Ev­ery ci­ti­zen would pay for a policy to cover pre­ven­tive care and ma­jor med­i­cal events. The sav­ings in over­head would pay for car­ing for the poor. One can also ar­gue that a healthy cit­i­zenry is es­sen­tial for na­tional se­cu­rity.

Rather than a “right,” pa­tients must [also] as­sume re­spon­si­bil­ity for their own health. There should be penal­ties for peo­ple who be­come obese or use al­co­hol and drugs to ex­cess. So­ci­ety must also de­cide on whether or not to pro­vide non-es­sen­tial health care. Should a 70-year-old man with a sore knee have a joint re­place­ment? As­pirin-like drugs, hot packs, a brace and a cane might do just as well.

TOTI: DO DOC­TORS “GAME” THE RE­IM­BURSE­MENT SYS­TEM?

Most doc­tors are hon­est and hard­work­ing, but too many health pro­fes­sion­als have taken on the dis­hon­est ethics of the cor­po­rate world. The [U.S.] De­part­ment of Jus­tice has found over­billing, billing for non-ex­ist­ing pa­tients and overuse of dan­ger­ous pro­ce­dures such as car­diac catheter­i­za­tion. There is a com­pli­cated cod­ing sys­tem for ev­ery dis­ease, op­er­a­tion and di­ag­nos­tic test. One way to “game” the sys­tem is to up­grade the code to a more com­plex di­ag­no­sis. Med­i­cal so­ci­eties spon­sor sem­i­nars for doc­tors to learn how to get the most out of the sys­tem. Some doc­tors or­der ques­tion­ably nec­es­sary tests that are per­formed in their own lab­o­ra­to­ries or use med­i­cal de­vices made by com­pa­nies in which they have in­vest­ments.

TOTI: AD­VICE TO THOSE CON­SID­ER­ING A MED­I­CAL CA­REER?

It is still a great pro­fes­sion; go for it. In col­lege take cour­ses in the hu­man­i­ties and then learn all you can about gen­eral medicine, so you un­der­stand the “whole pa­tient.”

TOTI: WOULD YOU BE A DOCTOR AGAIN?

Yes. It would be fun to set frac­tures, op­er­ate, even de­liver ba­bies. At the end of the day, I would hold hands with an ane­mic old lady, look into her eyes and say, “Take two of these pills ev­ery morn­ing and you will feel a lot bet­ter.”

MOST DOC­TORS ARE HON­EST AND HARD­WORK­ING, BUT TOO MANY HEALTH PRO­FES­SION­ALS HAVE TAKEN ON THE DIS­HON­EST ETHICS OF THE COR­PO­RATE WORLD.”

—DR. JOHN RAF­FENSPERGER

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.