Everyone concerned with health care reform should read this book. From President Barack Obama and Speaker John Boehmer to the elderly and uninsured, Americans could learn a great deal from Dr. Kozel's perspective. Maggie Kozel, M.D. practiced pediatrics in the military and in private practice, and she has a clear vision of what's wrong with our private system. She speaks out boldly about those bugaboos politicians wish would go away: universal health care, Medicare and Medicaid, our insurance system, and malpractice.
Dr. Kozel interned and did a pediatric residence in the Navy. After ten years, including stints as a general medical officer on board a ship and a pediatrician at a base in Japan, she and her neurologist-husband left the military for private practices in New Jersey.
In the Navy, Kozel did not have to deal with toilet training, sleeping through the night, or picky eaters. She did what she was trained to do: keep children healthy. Nurses did the child-raising counseling. Cost was never an issue for either patient or physician, eliminating the third-party payer as a middleman and making possible the treatment of small problems before they became huge. The military long ago embraced universal health coverage, and it works well for them.
In private practice, she found that funding dictates medical care. It was morally impossible for her to turn away uninsured patients, yet she was squeezed by the demands of earning a decent living. She found herself practicing medicine in an environment where patients feel that every cold deserves an antibiotic; her lectures on the dangers of too many antibiotics fell on deaf ears. Our culture that wants an instant fix, and parents felt entitled to get something for their money. Pharmaceutical advertising comes into play here too, for patients "know" there is a magic pill for everything, and they don't want to hear about the danger of over-medicating.
Malpractice also rears its ugly head. It is, Kozel says, not about failure but about poor outcomes, devastated families, and lawyers making a lot of money. Some 91% of physicians order more tests and referrals than necessary to protect themselves against malpractice suits, thereby increasing costs to all consumers. Malpractice insurance is outrageously expensive (it varies according to specialty), and that cost is also passed on to consumers and taxpayers.
Insurance policies, decided on by businessmen in board rooms and not physicians, shape patient care. One-fifth of physicians say they do not make decisions based on what is best for the patient but rather on what insurance pays for. As a trained pediatrician, Dr. Kozel found herself discussing toilet training, sleeping through the night, and eating habits—all that a twenty-minute time slot, because insurance won't pay for nurses to fill this role.
Kozel suggests that budget-minded politicians who want to cut or eliminate Medicare and Medicaid don't realize the consequences. Slashing those programs would send patients to the emergency room on the public dime. Medicare and Medicaid patients today account for more than half of those treated for obesity-related illnesses, costing the country about $92 billion annually. Kozel lays the blame on consumer advertising and patients who haven't been educated on nutrition. But as a practicing pediatrician in private practice, she had no time for more than mention of nutrition with the parents of children she saw.
Kozel presents her theories against a backdrop of case histories (names disguised), making it real and immediate. Citing the need for a national electronic health care database, she tells of an abused child, burned with cigarettes, starved for food and affection. The child was hospitalized and treated for malnourishment; dermatologists works on the burn scars on her face. But child welfare officials returned her to her parents, and the family moved, leaving no trace. An electronic record would have followed that child wherever she went.
Eventually Kozel suffered a classic case of burn-out. There were too many high pressure days, too many twenty-minute visits when she needed two hours with the family, too many sleepless nights on call waiting for the phone to ring. Now she teaches high school chemistry to intelligent and receptive girls at the upscale private school her daughters attend. She enjoys more time with her family and sleeps through the night. But in her heart she will always be a pediatrician, and she misses the medicine she practiced ten or fifteen years ago. She would volunteer or work part-time in a clinic but neither would pay for her insurance. She has reluctantly left medicine, driven out by the system. It is ultimately our loss, for how many others like her are out there?
Dr. Kozel's memoir shows that our system drives some of the best, brightest, and most compassionate out of the practice of medicine. Health care reform? You bet!
Maggie Kozel attended Fairfield University, took her medical training at Georgetown University, and did her internship and pediatric training in the Navy. After twenty years, she left medicine to teach high school chemistry. She lives in New Jersey with her husband, a neurologist, and their two daughters. Visit her blog.
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