Pity the poor doctors, all those kindly Marcus Welbys, all those intimidating Ben Caseys . . . Once they were akin to gods, deigning only upon occasion to dispense a tidbit of information along with a pill, the nature of which was itself non of the patient's concern. . . .
It's all changing, in large part because of pressures from a curious set of circumstances: rebellious (and health-and body-conscious) patients on the one hand and escalating health costs on the other.
Add to this a healthy serving of 20th-century stress-related, medically-resistant ailments and a few doctors with the vision to see the wall graffiti -- and beyond -- and what do you get?
For one thing, second opinions.
Ask Ben Casey to recommend someone to give another opinion?
Nevertheless, that is what is being encouraged -- at least for elective (nonemergency) surgery -- by major healthcare carriers, many doctors, medical consumerists and, in its own cautious way, even the American Medical Association.
Since the early 1970s, there have been reports -- by the arena-full -- of unnecessary operations.
Newly-aware women, and activist women's groups began to question the number and need for hysterectomies or radical mastectomies.
Others, including insurance carriers, federal legislators and appropriate sections of the Department of Health and Human Services began to calculate the costs of even a relatively small percentage of unnecessary operations -- and they were counting cold hard cash.
About 18 months ago, the AMA House of Delegates -- which sets that organization's policy -- passed this resolution:
"Recognizing that the advisability of surgery or other specific therapy can be a matter of opinion, the American Medical Association affirms the right of a patient or of a physician to seek a second opinion freely from any physician of his or her choice."
(We are, of course, speaking of elective surgery and treatments, not emergency procedures such as an appendectomy or surgery after an accident.)
Federal and state governments, through Medicare and Medicaid, have gone even further in a demonstration project requiring a second opinion before surgical costs can be reimbursed. (The AMA is strongly opposed to such requirements.)
But health-insurance carriers are moving quickly to make second opinions a national habit.
Prudential, which has been promoting second-opinion coverage under two plans for about a year and a half, now has some 600,000 people covered, about half in each program. (One simply makes a second surgical opinion eligible for benefits and the other, called an "incentive" program, offers a greater percentage of surgical benefits when two prior opinions were obtained.
A number of studies have indicated that most second opinions merely confirm the first, but even in these caes 20 to 30 percent of differing opinions can give financial justification for the programs -- a second opinion, on the whole, being less expensive than any surgery.
Most physicians now are at least resigned (if not enthusiastic) about referring patients for second opinions. And many physicians and surgeons actively encourage their patients to seek one.
But how do you ask your doctor to refer you to someone else without hurting his feelings? Or make him miffed with you?
Some authorities believe you should probably not burden you own doctor with the referral, but get it form your insurance company, or someone recommended by, say, the American Heart Association or the Cancer Society, even by a friend's doctor. Prudential has signed agreements with 19,000 board-qualified specialists to whom it refers clients for second opinions.
And HHS has instituted a hotline, so that anyone can dial a toll-free number and be referred to a local-area specialist in his or her problem. The number: 800-638-6833 (except in Maryland, where it is 800-492-6603). Callers average about 1,000 a month, according to HHS.
Also available is a government brochure which describes the procedure, suggests when a second opinion is appropriate and includes questions to ask. "The final decision regarding non-emergency surgery," it notes, "is up to you. After all, it's your body. Isn't you body worth a second opinion?"