Medical Maladies
Palley, Howard A.
Medical Maladies Reviewed by Howard A. Palley Recently a rash of professional and popular critiques of the nation's health care system has appeared. The two books reviewed here deal with major...
...One interesting point which Gross raises is whether or not the high status, research-oriented physician who is eagerly sought by "teaching" hospitals is necessarily a good teacher of necessary clinical skills...
...He discusses the University of North Carolina study of general practice which noted a prevalence of inadequately kept medical histories and poor medical examinations...
...Gross' belief that the problem of quality medical care ". . . resides in two areas: the medical and philosophical —not economic or political—environment which society creates for the doctor . . ." is, in my opinion, naive...
...Gross places the blame for medicine's ills on "the physician" rather than on the social-institutional structure in which the physician operates...
...Such advertising stresses the curative value of the product, often not elaborating on the presence of contraindications or side effects...
...This figure included rates as high as 41.8 for the Negro ghetto of Central Harlem to a rate as low as 13.8 for the middle class Mas-peth-Forest Hills area in Queens...
...Odin W. Anderson has noted, is that our best medical care ". . . is as good as Sweden's but a random patient in that country has less chance of having bad medical care than in the United States...
...It might be well to note a comment by Dr...
...The late Senator Estes Kefau-ver's Senate Subcommittee on Anti-Trust and Monopoly revealed that frequently more than twenty-five per cent of drug producer costs are spent on advertisements and "detail-men...
...He has not really arrived at an analysis of why these problems abound...
...The two books reviewed here deal with major providers of health care services —the hospital and the physician...
...Hoyt has presented a fragmentary analysis of the problems of the hospital system...
...Gross describes the "businessman's association" orientation of the American Medical Association, the lack of professional self-regulation, and the growing problem of malpractice suits...
...Much of the unevenness in levels of hospital service is related to the high cost of hospital care...
...Gross reviews many critical problems facing the medical profession...
...it is not an analysis at all...
...Shortcomings include: an uneven distribution of necessary equipment, an unbalanced allocation of skilled physician and nursing staff, and differential standards of supervision of hospital services by professional personnel...
...Edwin P. Hoyt's Condition Critical: Our Hospital Crisis catalogues the shortcomings of our hospital system— or, more properly, lack of system...
...Gross points out that the fragmented nature of practice— due to specialization and solo practice —often results in inadequate records, since patients frequently must change physicians...
...It is, however, a telling indictment of some of the current ills of medical practice and the institutions influencing medical practice— the pharmaceutical industry, the American Medical Society, and the unsupervised fee-for-service medical practice...
...Gross also notes the frequently poor pharmacological judgment of physicians, a result of the influence of misleading, repetitious drug advertisements...
...As this is a significant achievement, Gross has performed a public service...
...In 1964, the infant mortality rate for New York City was 26.8 per thousand births...
...In spite of this reservation, I believe The Doctors graphically portrays problems of medical practice which the medical profession and the public cannot ignore...
...Milton E. Roemer of the Sloane School of Hospital Administration at Cornell University: "Everybody . . . should contribute to . . . hospital financing . . . [Hospitals] are at least as important as public utilities, like water, fire protection, or education...
...One might add that such contributions would have to extend beyond the limited nature of compulsory hospital insurance for the elderly and current Federal-state reimbursements for "medically indigent" patients...
...Martin L. Gross' The Doctors is subtitled "A Penetrating Analysis of the American Physician and His Practice of Medicine...
...The book fails to live up to its billing...
...The disparity in the quality of health care can be graphically illustrated by infant mortality data for New York City...
...The Doctors does not place the blame for the problems of health and medical care in the proper cultural perspective...
...The tragedy, as Dr...
...He also notes that there is a convention of charging the paying patient a sufficient amount to cover—at least partially—the cost of ward services...
...Hoyt notes that in hospitals with medical school affiliations and post-graduate teaching programs, many expenses of medical education are written into the patients' bills as representing hospital care costs...
...One wishes that Gross had reviewed the effect of the 1962 Kefauver-Harris Act in its attempt to regulate the steps leading to the marketing of drugs...
...These divergencies exist within urban areas and between national regions...
...Gross suggests that an emphasis on studying "esoteric" conditions may distort medical school curriculum and clinical teaching...
Vol. 31 • February 1967 • No. 2
