The old adage “a doctor who treats himself or his family has a fool for a doctor” and its variation, “the doctor who treats himself from medical books could die of a misprint,” has now been extended to “the doctor who treats himself with medical software could die of a computer virus.”

The Business Journal (7/19/93) lists the 25 highest paid executives of local public companies. Five of the top 15 include the following along with their rankings:

The Los Angeles Daily News reports (reprinted in SF Chronicle 9/2/93) that managers of Health Net stand to collect $100 million for stock that they paid $1.5 million for last year, if its proposed merger with QualMed later this year is completed.

Nearly one in five persons admitted to nursing homes as self-payers are likely to convert to Medicaid within a year, according to Dr. Vincent Mor of Brown University. That’s all the time it will take for them to spend their savings and liquidate their assets to pay an average of $25,000 a year in nursing home costs… according to Spectrum (Sacramento, 8/1/93). The Brookings Institution estimates that the yearly cost of nursing home health care costs will be $158,275 by the year 2020.

Miles Benson (Newhouse News Service) reports from Washington that President Clinton’s top advisers and his most loyal supporters in Congress admit that health care reform is a leap in the dark – but they are betting they can design the parachute on the way down. . . . After three-fourths of a year, the task force has been unable to crack the riddle of health care reform: how to achieve the conflicting goals of universal access, universal quality and universal cost control. . . they admit it will take 10 years to fully develop with many changes along the way. . . It’s hard to teach politicians in 10 years what it took those of us in the trenches longer to learn and understand. Let’s keep the dialogue going with everyone possible. We have friends we have not yet met. The politicians have enemies they will eventually have to account to. (Sacramento Union 8/15/93)

The Wall Street Journal (8/9/93) reports that “hospitals are now jumping into the business of ‘wellness’ – that fuzzy term that can encompass everything from meditation classes to aerobics to yoga . . . belly dancing is offered at Rush-Presbyterian Hospital in Chicago . . . but that trend, some critics say, may lead to patients getting herded into expensive tests and treatment they might not need.”

One of our surgeons returning from a three-week vacation in Israel reports that private practice is booming. The near universal coverage from payroll deductions is deteriorating and people are seeking out private doctors they have to pay above and beyond the deductions from their paychecks that would take care of their medical problems. He also reports that solo practitioners are doing better than groups practitioners. The patients are paying $200 or more for a consultation and $80-100 for a follow up visit . . . Sounds as if they like their doctors as well as American women like their hairdressers. One woman told me she’d travel 30 miles to see her favorite hairdresser even if it cost more. Can we regain the hairdresser’s importance?

Mark Hunter reports (Bee Forum 8/29/93) that France, a country often envied for its system of universal health care and tradition of medical excellence . . . knowingly allowed at least 1,000 people to receive blood or blood products contaminated by the virus that causes the disease. Three hundred of those people–mainly hemophiliacs, many of them children–are already dead. The rest are going to die, barring a miracle. . . Dr. Leibowitch, an immunologist in screening blood stocks, reported on December 12, 1984 that he found 2,500 HIV contaminations per year (7 HIV infections per day) and issued a written warning and called the French Ministry of Health. On May 9, 1985, another scientist, Dr. Garretta, armed with his data, wrote to the Ministry of Social Affairs that cleaning up the blood supply was “an absolute urgency.” The official in charge said that a “compromise” had to be found “between the imperatives of public health and the economic constraints.” We have to keep this message before the public, the patients we serve, that when their health is a part of the federal budget, their health, their life, their death will always be secondary to fiscal constraints.

Parker & Hart in their comic strip, “The Wizard of Id,” show bureaucrats desperately searching for anything that’s left to be taxed and finding the only thing not taxed is “Greed.”

One of our internists reports that FHP gave him his card and listed him as his own primary care practitioner. The other doctors at the luncheon table were quick to point out that the hospitals have rules that physicians can’t treat their own families. Another doctor pointed out that these rules did not preclude treating oneself. . . Can’t you already see this doctor admitting himself to the hospital and every day he takes his morning walk to the nursing desk, picks up his own chart, writes his own progress note and then writes the orders he requires, and returns to his room waiting for the nurse to carry them out?

Overheard from a surgeon in the staff room: a patient bartered for his cosmetic job with vintage wine. Another full circle from the rural doctor who took a quarter of beef for an appendectomy in yesteryear? TB treatment has also come full circle. Having ceased being a surgical disease in 1951 with the advent of isoniazid, the current TB epidemic, 40 years later, is bringing back discussions of pneumoperitoneums, thoracoplasties, and resections. A local phthisiologist remarked that once as he was giving a pneumo, the patient looked up and asked, “Doctor, is there a cure for this treatment?” As old diseases become new and different problems, it is noted that “People are dying today who never died before.”