Last week, I wrote a letter to the editor for the Rocky Mountain News responding to Paul Campos’ column on “myths” about American healthcare. It was published in full on the web, albeit apparently not in the print version. Here it is:

Paul Campos (“Our Sickly Healthcare,” Jan 30) notes the enormous influence of the government on America’s ailing market for medical care. Yet he misses the obvious: government meddling is the fundamental source of those ills. His proposal for more government-controlled medicine–for socialized medicine–would be a disaster for medical providers and patients alike.

Already, government bureaucrats set prices by arbitrary fiat via the Medicare system, then overwhelm doctors with paperwork and regulations. Already, consumers are encouraged to pursue medical care without regard for cost, thanks to tax laws encouraging employers to provide medical insurance for even routine expenses. Already, taxpayers are burdened with the cost of ever-growing medical entitlement programs. Already, FDA regulations drive up the cost of life-saving drugs and prevent doctors from prescribing drugs known to be safe. The result of that government meddling is an expensive bureaucratic labyrinth that prevents healthcare providers–doctors, nurses, drug companies, hospitals, clinics–from providing the best medical care for the patient’s dollar.

The solution to these problems is not more paternalistic government regulations, bureaucracy, and entitlements. It is to allow–and require–people to take personal responsibility for their own health by separating medicine and state.

Diana Hsieh
Sedalia

I was pretty pleased with the letter, particularly with the fact that it didn’t take me too long to write. (RMN allows comments on letters; so please post away!)

The forces of socialism are gearing up to impose government-controlled medicine on Colorado, so I expect to be writing more on this topic over the next year and a half. (I’ll say more about all that later.)

After a busy weekend on call at our Level 1 Trauma Center, I thought I’d post some examples of classic medical slang. Here’s a related list, with a more UK flavor. And of course, there’s a Wikipedia entry. Most of these terms are never used in front of patients, for obvious reasons.

Angel lust: a male corpse with an erection (not uncommon). Is also sometimes used to mean death that occurred during intercourse.
BFH: Brat From Hell, usually accompanied by PFH, i.e., Parent(s) from Hell
Bobbing for apples: unblocking a badly constipated patient with one’s finger
Bury the Hatchet: accidently leave a surgical instrument inside a patient.
Code brown: Incontinence-related emergency
DBI: Dirtbag index, which is calculated by the number of tattoos on the body multiplied by number of recentmissing teeth, to estimate days without a bath
Donorcycle: motorbike, the biggest cause of donated organs!
FTF: Failure to fly, for attempted suicide victims
GPO: Good for Parts Only
Journal Of Anecdotal Medicine: The source to quote for less than evidence-based medical facts
N=1 trial: Polite term for experimenting on a patient
Neuro-fecal Syndrome: S**t for brains
Organ recital: A hypochondriac’s medical history
O-sign: Found on the very sick patient who lies with mouth open. Precedes Q-sign
Q-sign: Following the O-sign, it’s when the terminal patient’s tongue hangs out of their open mouth
Rule of five: If more than five orifices are obscured by plastic tubing then the patient’s condition is critical
TFBUNDY: Totally f*cked but unfortunately not dead yet. Best avoided in the medical notes
TUBE: Totally unnecessary breast examination
UBI: Unexplained beer injury, for all those hungover people on Sunday mornings with black eyes or swollen knees and no idea how they’d got them
Whopper with cheese: Fat woman with yeast infection

Although this sounds suspiciously like an urban legend, there is a supposedly true story of one doctor who had scribbled TTFO (“Told To F*** Off”) in a patient’s chart. When the case later went to trial, the doctor was asked by the judge what the acronym meant, and luckily for him he had the presence of mind to say: “To take fluids orally”.

It is commonly thought that doctors swear the Hippocratic Oath. However, Paul never swore to anything like this:

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Paul vaguely remembers swearing to this modern version upon graduating medical school instead:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Boy, is that ever a snoozer! Surely it’s no longer necessary for doctors to promise to forebear taking sexual advantage of the slaves in the houses of the patients they visit. (After all, what doctor makes house calls these days?!?) Still, an oath with a single inspirational purpose would be more appropriate than that disjointed list of nags.

I’m feeling a bit ill this morning. I’m not surprised, since I just read Malcolm Gladwell recent article advocating socialist medicine. Apparently, my husband should be sold into slavery so that a few idiots with rotting teeth can smile again.

I’m quite serious about socialist medicine meaning the enslavement of doctors. If our government ever voted itself control over our health care, doctors would not be permitted to practice medicine except under the terms dictated by government bureaucrats. My husband would be told what treatments he could offer, what equipment he could buy, what fees he could charge, which patients he can or must accept, and so on. If any of his patients wanted to pay him more for some safe and effective treatment unacceptable to the government, he could not offer it. (He would be exploiting their need!) If too many doctors refuse to work under those conditions — as I know Paul would — the government could follow the lead of Pennsylvania by requiring doctors to ask for permission to quit, retire, or move to another state. Of course, some doctors would welcome socialist medicine, but such happy slaves are still slaves.

Given the well-known disasters of socialist medicine — like ever-rising costs, long waits for diagnosis and treatment, substantial lags in technology, treatments not offered, and so on — for an intellectual to pretend that “universal health care” would simply extend our high standard of medical care to all is inexcusable.

Certainly, much is wrong with our current health care system. Yet all the serious, chronic problems are rooted in our decades of government intervention. The government has substantially distorted the market with its massive regulatory schemes and ever-expanding welfare programs. For example, the unprecedented use of employer-provided health insurance to cover normal, expected medical expenses is a direct consequence of government wage freezes during World War II. For example, since insurance companies determine their payments based upon the arbitrary fee schedule of Medicare, doctors are paid very poorly for reading those all-important mammograms, even though they assume a huge malpractice risk in doing so. The solution to these kinds of problems is to eliminate the source government intervention, not to increase it.

My mood was slightly improved upon re-reading Leonard Peikoff’s excellent essay “Health Care is Not a Right“. Altruism, collectivism, and statism drive the engine of change for socialist medicine — and so the battle must be fought in moral terms. Economic arguments about the practical effects of socialist medicine are a helpful adjunct, but by themselves, they lapse into absurd irrelevance.