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Who needs doctors?

By Doctor X
A physician practicing in the state of Pennsylvania.

When the dairy farmer Tevye asks his wife Golde if she loves him in “Fiddler on the Roof”, her indignant lament is that 25 years of being a housewife easily surpasses the threshold for the definition of that amorous word. Poor Tevye’s question really aims at the heart of individual choice. If the relationship is prearranged, are the feelings somehow less than the conscious and passionate eros that guides at least the beginning of most marriages?

It’s hard to imagine the dilemma in a culture where personal choice, or the illusion of it, is a pair of Nikes freeing us to “Just do it,” and a Microsoft program asking, “Where do you want to go today?” The images sprinkled between the text in The New Yorker, People and Travel & Leisure hint that technology and rubber are synonymous with free choice. But that plastic card in the wallet that identifies your health plan is a schoolmistress’s punitive ruler. “Take that,” she declares to the insolent 38 year old male who dares to choose a doctor to provide a pre-exercise physical before working off the choice of too much creme brulee. Doctors shall not be chosen, they shall be assigned.

It doesn’t matter who your doctor is, anyway. Unlike Tevye, we do get to choose our spouses in America, and we certainly get to choose our friends and TV dinners. And doctors, after all, are all alike. They are even addressed with the same prefix. As a matter of expediency, it might be best to drop the surname, burly and fat in some, and singularly short and scraggly in others. A physician’s uniform, similar to those worn in private schools, could easily be patterned to standardize the process of treatment. Replete with aseptic cap and mask, it would be impossible to identify one’s doctor even if choice had been an option.

A uniform for patients could also be fashioned. A woman suffering a yeast infection could don, for example, a uniform with a yuk face, similar to the emblems put on poisons to keep young children away. Such external documentation would speed the process of examination and treatment. In this glorious age of icons and clicks, a dockU (abbr. for doctor uniform) could, like a board of colorforms, be covered with the velcro of simple pictures of treatments: a hypodermic syringe for injection, a moldy bread for penicillin.

As the patients are transported on a conveyor belt, the nameless physician will peel off a treatment, easily determined by the printed cotton the patient is wearing, and stick it on the patient uniform so that a clerk, who needn’t even be literate, can study the picture and place the appropriate medicine in a brown bag for easy exit.

Wait! How will the patients know which uniform to wear? Patients don’t usually diagnose themselves. The answer is that medicine is not an exact science, stupid! It is also an art. And art, or at least pictures on uniforms, is what this new era of health care is really all about.

Surgery, of course, is different. It requires time to heal, something an even electronically challenged conveyer belt wouldn’t allow for. But, like college curricula, many surgeries are merely electives, and could easily be delayed until lasers are everywhere. Stand your battered appendix right up to the ray—don’t be afraid—and like an ear piercing, the offending lobe is burned away to the hymnals of George Lucas.

Obstetrics, a field which often gets pre-empted by the taxi driver carrying the laboring patient en route, has already taught us to accept that we don’t even get to choose our taxi drivers, not even the ones who deliver our babies.

Likewise, psychiatry, which is all about dispensing the Right Pill, is better devoid of human contact. The notion of a caring healer who understands the patient is merely a Jungian Archetype, something predrawn, or at least pre-fee-for-service. A glass of water is all that needs to accompany the treatment these days. And that is something, let’s face it, that doesn’t really require a medical degree.

Like the inference of a seminal legal paper, the evolution of this thought argues that personal choice of doctor isn’t really the ultimate query. The astute question is, do we really need doctors at all? And the answer to that is as simple as separating two words illegibly far apart. Like the two words, Manage and Care which, when really separated, command to the populace: just Manage.

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