Open Forum: Phineas returns

“Can you believe this guy?”

I looked up from my Nook. “What are you listening to, Phineas?”

“Marketplace, that NPR program about investing, business stuff.”

“And the reason you are listening to Marketplace is . . . ?” I looked over at my friend, trying to make a connection.

“He just said that doctors are no different than T-shirts, doesn’t matter where they’re made.”

I was interested now and listened to the interview. “So he wants to bring doctors here from Europe and Mexico to set up on every street corner, flood the market, and drive down the cost of health care.”

“Man, I haven’t even met my doctor. The assistant is great, but did only two years of medical training after college.”

“Our new reality is a two-tier system of medical care, which is set up for midlevel providers to identify complicated problems and refer you on to a specialist,” I said.

“And you better get a good one,” replied Phineas. “Otherwise you’re run through the mill for every test in the book before you find someone who can figure it out.”

“We all hope your physician will have sufficient training and experience to listen to your story, thoroughly examine you, make the correct diagnosis, order cost-efficient tests, and then prescribe up-to-date, evidence-based treatments that you will a) agree to do, and b) can afford if possible,” I countered.

“But this guy wants to hire docs from Europe who are used to making 50 percent less than U.S.-trained docs,” said Phineas. “What’s to stop these new guys from going for the specialties with the big U.S. paychecks instead of primary care?”

“The system requires foreign-trained physicians to undergo the same certification processes in residency and fellowships as U.S.-trained physicians,” I replied. “But the current system does not prevent physicians from selecting the highly reimbursed, procedure-based specialties.”

“That takes years,” Phineas said. “Won’t it cost a lot of time and money?”

“The idea is to guarantee that your physician has been trained to a standard of competence, if not excellence,” I answered.

“Back to T-shirts,” said Phineas. “Bargain-basement, Jockey, or Polo?”

“Our commentator believes physicians the world over are trained equally well, can communicate effectively, are versed in the nuances of the local culture where they practice, and are all motivated by only the highest patient care ideals,” I said. “Unfortunately, his idea is to streamline the certification and verification processes and trust things will all work out.”

“If he believes that, he didn’t pay attention to what happened with the crooks selling toxic mortgage investments, while no one was paying attention.”

“Phineas, I’m impressed. You’ve been keeping up.”

“Oversight to keep it right, before it all goes in the can, my man.” Phineas smiled.

Greg Kujala is a resident of Winchester.