The Special Doctor-Patient Relationship

Re “Patients Are Not Consumers” (column, April 22):

Bravo to Paul Krugman. As a physician for 44 years, I have seen the sick person seeking medical care transformed from a patient to a consumer and, like Mr. Krugman, I have been sickened by this.

Raised in a family of doctors, I was fed on medical ethics. Vulnerable patients rely on the ethical principles of their physicians. They should never have to fear that their physician will look at them only as consumers of the commodity called health care: fair game from whom the largest possible payment should be extracted.

Most physicians are motivated first by the desire to do good, to help their patients, not by greed. We will do more to help the situation by appealing to their ethical principles rather than to their business prowess.

It is time for us to join the rest of the industrialized world and treat health care as a social need instead of as a commodity. A Medicare-for-all national health plan would transform the patient back to what he is: a person in need of care, not a “consumer.” The Independent Payment Advisory Board created under the new health care law would fit such a plan.

ELIZABETH R. ROSENTHAL
Larchmont, N.Y., April 22, 2011

To the Editor:

Paul Krugman’s column answers a fundamental question: Is health care a right, like elementary education, or is it a privilege for those who can afford it?

RACHEL FRADKIN
New York, April 22, 2011

To the Editor:

While patients may not be consumers and the Independent Payment Advisory Board is undoubtedly necessary, I disagree with Paul Krugman that bringing consumer choice to health care is a bad idea. We cannot rely upon the government alone — and we certainly cannot rely upon insurers and providers — to rein in spiraling health care costs.

We need to give patients a role in the process of reducing costs, supported by three essential types of information: the efficacy of various treatments and procedures, the quality of the providers performing them and the difference in prices charged by these providers. Only by bringing informed and knowledgeable patients into the conversation will we have any hope of controlling costs without sacrificing quality, health and patient satisfaction.

MICHAEL G. PARKER
Chapel Hill, N.C., April 23, 2011

To the Editor:

Have you ever tried to do “comparison shopping” for medical services? I have, and I couldn’t get one single hospital or provider to answer my simple question: “How much do you charge for a mammogram?”

Can you imagine “comparison shopping” for something as complex as surgery? The only ones advertising prices for procedures are plastic surgeons and other providers of purely optional medical services.

Doctors and hospitals charge high rates because they know the insurance companies are going to knock their payments down by 50 percent or more. Adding a layer of for-profit to the cost of medical care, as suggested by the Republican budget plan, is obviously not going to bring down the cost.

KATHLEEN HOPKINS
Oak Park, Ill., April 22, 2011

To the Editor:

Thank you to Paul Krugman for pointing out what was once obvious, that the patient-physician relationship should be a sacred one that transcends all the financial issues that have come to burden it.

Intelligent rationing is not only necessary when dealing with large populations to allow for the fair distribution of limited resources to achieve the greatest good for the greatest number, but even has a role when dealing with individual patients. Many of the latest diagnostic and therapeutic advances can potentially harm patients and must be used only when there is a reasonable chance that they will benefit the patient.

We must not forget the great value — diagnostically and therapeutically — that a physician can provide through the personal and sometimes magical interaction with a patient, unencumbered by financial or political forces.

 MITCHELL A. ADLER
New York, April 22, 2011

The writer is an assistant professor of clinical medicine at the New York University School of Medicine.

To the Editor:

As an emergency physician, I fully agree with Paul Krugman on consumer-based health care in America. Although I was trained in emergency care to deal with the sickest patients, much of my time is spent seeing less sick people who find emergency care a convenience.

Physicians are powerless to change this culture of entitlement because hospitals continually put “patient satisfaction” above practicing evidence-based medicine. It is sad that “satisfaction” often means meeting consumer expectations by prescribing unnecessary antibiotics or performing radiography for “customers” who won’t be satisfied otherwise. Many “customers” want all possible services all the time. This convenience comes at an incalculable cost.

We do our best to do what’s right, but we are constantly forced to choose between “customer satisfaction” and evidence-based, cost-effective medicine. More worrisome is that this consumer mind-set may play a large role in bankrupting our nation.

 ANTHONY J. DOWIDOWICZ
Saranac Lake, N.Y., April 22, 2011

To the Editor:

Paul Krugman’s apt critique of Republicans’ misconstrual of medical patients as “consumers” points toward a more pervasive cultural pathology.

Whereas formerly we were patients, parents, neighbors, citizens, congregants and so on, now in most of life we’re just consumers. This crimped conception flows directly from the modern American propensity to deify the free market.

While reducing us to consumers, free market fundamentalism also corrodes, corrupts or demonizes all other basic social instruments, like effective government programs and regulations.

The deification of the free market cannot coexist with a robust concern for the common good and a dignified regard for what it means to be human.

 RICHARD E. SCLOVE
Amherst, Mass., April 22, 2011