At the age of 46, disillusioned with modern medical practice, Dr. Margaret Kozel decided to end her 17-year-career in primary care pediatrics. She cites some of her reasons in her blog post, Confessions of a worn-out pediatrician.
“Our system of paying for health care and the stresses on today’s families were pitting my best medical judgment for the child against all the other worries and desires of the parents,” Dr. Kozel writes. “The economics of health care trickled down into my exam room, into the conversation between doctor and patient, distorting the relationship.”
High on her list of complaints are the inequalities inherent in our American healthcare system. Those who need pediatric care the most—poor and underinsured children—are the least likely to access it. And in those cases where health care is available, third-party payers dictate standard of care, sometimes with substandard results.
“Private insurance companies decide who gets paid for what, so pediatricians treat serious mental illness with little psychiatric training, use nebulous tools to diagnose attention deficit disorders, and valiantly tilt at the windmill of childhood obesity not because we can do this most effectively, but because we are the only professionals who can get paid to do so.”
“At the other end of the treatment spectrum, free market forces often urge us to over-intervene with minor illness, where less really would be more.”
“Clinical truth has only grown more obscure since my medical school days,” Dr. Kozel muses in a separate NYT Well blog post. “Today, as we take on the hard work of health care reform, doctors continue to work under an avalanche of pharmaceutical marketing, malpractice threats and shortsighted health insurance strategies.”
“In an age when public health issues like obesity are what pose the greatest threats to our children, pediatricians will need to move out of the confines of the fee-for-service exam room to advocate for effective healthcare policy in the wider community.”
Despite her misgivings, Dr. Kozel maintains a positive outlook for the role of pediatric healthcare in the future.
“I believe our society will eventually see the economic sense and moral imperative of universal health care coverage, paving the way for healthcare to be designed by health professionals, and to be viewed as a right and a responsibility, rather than a commodity to be purchased. I believe that pediatrics can evolve, too, in a way that will truly meet our society’s health needs.”
Follow Dr. Kozel’s opinions on these and related issues at Barkingdoc’s Blog.