Meet Dr. John Raffensperger
Sanibel physician’s memoir, a pioneer in children’s health
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