* You move to a new city where you have no personal ties to the health establishment. How do you pick a doctor? With some 5 percent of American doctors "impaired" by incompetency, alcoholism or drug abuse, are you "playing Russian roulette with your life"? Your children's lives?
* Your doctor sends you a bill for some laboratory tests that he routinely farms out to a medical lab. He charges you $75 for the tests, but how do you know how much the lab charges him? It might be $74.50, but it could be $15.50.
* Your doctor suggests a specific treatment for a health condition. You've read about alternative treatments for your problem. Do you have the heart to hurt his feelings or the courage to risk irritating him by suggesting a second opinion? And if you do and he says okay, do you just get his golf partner?
Although inflation seems to be diminishing, health costs are still skyrocketing. They went up 11 percent last year--three times the consumer price index for all items.
Moreover, "One out of five to one out of three patients leaves an American hospital with a medical problem caused by the care given," claims Yale University Medical School public health professor Lowell S. Levin. "That is an epidemic by anyone's judgment. Yet it is the best-kept secret in medicine."
Levin, although not a physician, is an authority and author on health-care delivery. He is part of a new movement that, its founders hope, will lend some backbone to the individual patient, too often found in a doctor's office worried, frightened, often in pain--and possibly naked, the ultimate vulnerability.
The People's Medical Society has its roots deep in the self-care health movement of Robert (Prevention Magazine) Rodale, which endows it with a certain cachet for many of the magazine's nearly 3 million readers. The connection also, however, damns the society in the eyes of much of the medical establishment--including its majority of dedicated, skilled, competent doctors who provide the care they were trained to give.
There is an air of confrontation between doctor and consumer these days. As the American doctor has abdicated his Marcus Welby image--at least partly by his failure to let his patients assume responsibility for their own health--plenty of snake-oil salesmen have stepped in to pitch their own nostrums to medically disillusioned consumers.
Medicine is probably not, by and large, as bad as some of the founders of the People's Medical Society might have you believe. Nor are the People's Medical Society founders (or Prevention Magazine) as off-the-wall as most doctors will claim.
This country's health-care crisis, however, is real. And it's very easy to generalize. There are doctors who say, flat out, that people should not be allowed to sue for malpractice under any circumstance; there are non-MD health professionals who suggest that all doctors are greedy charlatans eager only to feed their golf habit at best, their drug habit too often; and there are doctors who dismiss any alternative health care as "quackery," even as they gradually subsume such specialities as nutrition into their own spheres.
"Holistic" has become a dirty word to many doctors even though the practice of "wellness," the central tenet of holistic medicine, is spreading deep into the medical establishment.
The People's Medical Society (PMS) is a consumer health movement. As envisioned by Rodale, Levin and its other leaders, it will spark the formation of local chapters that will evaluate local doctors and hospitals and compare laboratory costs, doctors' fees, kinds and numbers of surgeries performed--and their success rates.
Lori Andrews, an attorney with the American Bar Foundation specializing in health and hospital law and a PMS board member, points out that a company in Peoria, Ill., has managed to save $2 million a year by monitoring employes' health providers more closely. The heavy-equipment company's most dramatic discovery was that the billed cost of the same blood test--performed at the same laboratory--ranged from $15 to $250. Cost to the physician: $9.
The company, which acts as its own health insurer, simply put out the word that it would pay a flat fee for that blood test. The results were so successful the system may be expanded to other services.
A local-area PMS, Andrews believes, could spot such discrepancies and, although lacking the authority to force a change, could publicize physicians' fee schedules. It is Andrews who draws the analogy of selecting a new doctor to playing Russian roulette. The 5 percent of "impaired" physicians, too often protected for too long by colleagues and hospitals, are treating, she says, some 10 million Americans.
But PMS is not aimed at individual physicians per se.
Says Levin, "We've become so used to accepting on faith all the medical pronouncements, edicts, advice, orders--all the military symbolism of organized health-care establishments--that we have, over the years, developed a passive acceptance . . . and haven't noticed that the answers are not coming out like they used to.
"We're no longer saying that adding more doctors is going to improve health. Or that building bigger hospitals will improve health, or even medical care . . . And now with changing patterns of disease away from acute to chronic, many people feel they have something to contribute to caring that they might not have had to curing.
"So we say, okay, we want more of the action. Now, where can we get it?"
For more information, write People's Medical Society, 33 E. Minor St., Emmaus, Pa. 18049.