That was a correct article for two years ago, but now there is a big change.  It not only is not up to the doctor what is done, but the patient now has no right either.  It is up to the insurance company or the health czar to decide and there is nothing you can do about it.  We doctors will always order more than necessary tests because we don’t want a shyster lawyer asking us under oath why we didn’t order it , so we just order it all.  It is nice for the patients and family to refuse to have the test and the refusal is documented.  Because of all the hassel and decreasing reimbursment doctors will place the patient on a tread mill and see as many as possible with minimal discussion or interchange with the patient.  That is a non-reimbursed service, so don’t expect it.  Since there is now a hugh shortage of doctors to take a patient, if a patient or family is abusive, they will find that they won’t be seen.  I don’t know any doctor who likes all this and many are just opting out retire or cut back severly.  But that is what the people voted for so I hope they all enjoy the results of their decision.  So sad.

This is a little like the “empowered students” that were created back in the late 1960s, and 1970s.  Back then teachers had large classes with good discipline even in the ghettos, there was no such thing as ADHD or “bipolar” disease, and students graduated with decent skills.  The methodology was top down, with lots of drill, discipline, and the teacher’s word was law.

Then students were “empowered”.  This meant that they were encouraged to argue with the teacher, wander around the classroom, and discipline was set aside in favor of discussion, and for those for whom discussion failed, an IEP “diagnosed” ADHD, bipolar illness, conduct disorder and the like.

It worked pretty well for the wealthy.  I taught my kids to read at home, (thus side stepping the “gaze and guess” methodologies that produced happy, empowered students who were functionally illiterate).  I also tutored math, and taught history and geography not to mention theology to both my kids, and found private schools that allowed me to select a higher functioning group of age mates, and a disciplined classroom setting for them.  Furthermore, I refused to permit the schools to test my oldest (who would CERTAINLY have qualified for both mental retardation, ADHD at age 5-10, and for bipolar and conduct disorder at age 12-16.  I also refused to permit the schools to test my youngest (who would have qualified for “Asperger’s syndrome).  By my refusal, I permitted them to remain mainstreamed in private school, while I tutored them, obtained private speech therapy, and worked on social skills.  They are now both normal, and very high functioning (my oldest is a Spanish major in college and a B student working independantly, and has never needed meds.  Her IQ is now in the high normal, rather than the subnormal range; My youngest is an A student in 7th grade and is highly popular (after a GREAT deal of work on social skills).

So student “empowerment” worked pretty well for me.  I would not have wished the schools beating my kids, and my oldest would certainly have received corporal punishment multiple times, had she grown up in the Washington DC public schools in which I grew up.  (I might add that in those DC public schools of the late 1960s, class size was 30-45 students and despite plenty of poor kids (of whom I was one) there was complete quiet, and NOBODY had ADD or other psychiatric illnesses..  There were no sports worth speaking of. For recess we messed about on the playground, or made dolls out of sticks and played house under the trees.

Student “empowerment” has worked less well for those students who are not blessed with wealthy, clued in parents who understand the limitations of psychiatric “diagnoses”.  The same public schools which gave me a life long love of reading, and learning together with a healthy terror of being called to the principal’s office now have more than 50% kids with ADHD, bipolar and severe conduct disorders which means that that CANNOT learn.  How odd that the US public health service has not come to investige this obvious EPIDEMIC that has struck down our city schools!  The schools now have smaller classrooms (under 20 kids), LOTS of “counselors”, lots of gym space with nifty sports teams, complete with uniforms etc, however learning has plummeted while students who are disabled and beyond the teachers help have skyrocketed.  But the students are empowered all right.  They stand around cursing and arguing with their teachers all the time.  So it’s all good right?

When the ignorant of the schools (the students) were “empowed”, one consequence was that “looking good” became more important than making a difference.  And there are so many ways to “look good” to the ignorant.  “Gaze and guess” reading makes teachers look good as they have happy classrooms filled with kids apparently “reading”.  Listening to unhappy, kids stumbling through a passage while reading out loud, and sounding it out does not “look good”.  Spanking troublemakers makes teachers look brutal.  Telling the same troublemakers that they have ADD and bipolar illnesses and have a DISEASE that they are not responsible for, but which the teacher is also not responsible for makes a teacher look “compassionate”.  Another consequence is that those teachers who really cared passionately about the students left, leaving those who were willing to call a struggling child “autistic” rather than risk “looking bad” in charge.

There will be consequences to patient empowerment also.  One consequence is that the easiest way to deal with these “empowered patients” is to simply say “I think you are way too complex for little old me”.  You are going to need to go to the Mayo clinic.  Oh won’t they accept your insurance?  Well, you should consider paying out of pocket.  Similarly, folks whose insurance expect that a medical visit will take 15 minutes but wish to spend another 1/2 hour discussing their disease will find that the only physician who sees them will be a concierge practice, that forces them to pay for the time they waste.  But the biggest losers will be the poor.  They will find that for all their new “power” they can’t find a doctor who can help them.  They are just too sick.  Just like the “empowered” students in my former public school, half of whom now fail to graduate.

If what people wanted was to actually empower students (or patients) rather than to make difficult students and difficult patients feel justified and better about theselves, while they waste everybody’s time, they would do the following.

1.  Let students take end of subject exams in all courses (grade school to grad school) and get an appropriate certificate of completion for high school, college etc.  This would empower students who manage to on their own learn the entire core curriculum of college to graduate and get on with their lives, without having to submit to the authority of a teacher.  The first two years of medical school could be handled similarly, the second two years are an apprenticeship that requires hands on instruction.  Similarly, while high school could be easily passed in this fashion, a subsequent degree in auto repair would require a hands on apprenticeship. 

This would mean that motivated, highly disciplined 15 year olds could go out and get real jobs and be really independent (“empowered”).  The rest, who did not wish to put in the work (or could not) would stay in school until they learned the material from their teachers.

2.  Let patients prescribe for themselves all noncontrolled drugs, and order all tests (and pay for them).  Let folks who have hypertension, study the material (it’s not that difficult), check their pressures, adjust their meds and do without a physician.  Let folks with diabetes, asthma, seizures etc do likewise. 

You would still need a physician for most surgeries, however most medical problems could be dealt with at home by “empowered” patients who actually had taken the trouble to study and understand their disease.  Many of them could become essentially expert in their fields, and they would frankly enjoy it, and would save vast oodles of money.  The rest, who did not wish to put in the work, (or could not) could go see a doctor.

There is a difference between truly being “empowered” to take charge of one’s life, and simply being an abominable nuisance.  Unfortunately, the folks at USA today do not understand that difference.