Medical Decisions

Was it only a generation ago that the family doctor was viewed, if not as God, certainly as the last word in health care? Not all physicians behaved imperiously, of course. Furthermore, until the last generation, physicians often were family doctors. They knew a patient's history, both physical and emotional. They may have been authoritarian but they also often had trusted relationships with those to whom they ministered. More recently, we see numerous physicians who encourage their patients to take active roles in choosing their own cures.

Now, with the introduction of managed health care, the pendulum has swung. More and more, patients must make decisions without the help of trusted medical advises and, in many cases, risk having questionable ones made for them by doctors who have one eye on the patient's well-being and the other on the policies of the health management organizations that are paying the bills.

The pronouncements of nonmedical personnel in far-off insurance company offices and of impersonal health panels stir the already boiling pot. At what age, for example, should mammograms begin? One study found that regular screening of women in their 40s would save one life out of 2,500. Its conclusion therefore was that mammograms for women of this age should be optional. Our view is that one life matters - even if it isn't yours.

"Gross recommendations for everyone is a very crude approach," a spokesman for the American Cancer Society has said. The statement has broad application.

Under managed care, however, the best course to take for the prevention of disease and the best form of treatment for each individual have given way to cost-benefit formulas. And in many cases the physician no longer knows each patient well and may no longer even be a reliable first resource.

Some of us, of course, are fortunate to have doctors who know us as individuals and and help us make informed decisions. The rest must learn to ask hard questions, weigh the answers, and go it alone

The question is, can we find the courage to learn enough, and in time, to act wisely on our own behalf? Up-to-date data on scientific studies, physician qualifications, and hospital performance is out there for the finding. Take the time to look.