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The hovering vultures: how greedy physicians prey upon patients.

They are more interested in lining their pockets than providing competent medical care, often performing unnecessary procedures at outrageous costs.

In the desert, when a distressed animal is on the verge of death, vultures gather above. This hovering horde of bone pickers sense, with great precision, the near-terminal condition of the creature. Patiently, with uncanny determination, the birds plot their moves. Then, at the very minute they witness the last gasp of their would-be feast, they strike. In short order, they have engorged their victim, ravenously consuming everything edible that hangs from the carcass. Finally, they depart, but behind they have left a warning, maybe meant as a boast. Scattered across the desert floor are the bones of their prey. Left to decay in the hot sun, they remain as a sign to the rest of us that another creature is just waiting to take advantage of our suffering.

Not all vultures operate in the desert, nor are they all winged creatures of the Cathartidae family, identified by their dark plumage and naked head and neck. Some can be identified by their white coats, luxurious automobiles, and average after-tax income of $120,000. Many have the initials M.D. or D.O. after their name. They often are spotted at meetings of local or state medical societies. Many migrate to warm-weather resorts in the winter or to Chicago in the summer - the nesting sites of the American Medical Association's conventions.

Even if you do not spot these vultures visually, you may hear them. They often perch on radio talk shows or leave their verbal droppings in the local newspaper. While their chirping tune can vary, it generally is recognized by complaints about Medicare reimbursement, patients' lawsuits, failure of consumers to understand how tough it is for birds of their feather, and the lack of respect most mortals have for such an important species. Indeed, it is this species - the Vulture Medicus - who today pose a very serious threat to most American consumers.

While economists are in dispute about whether we remain in a recession, the Vulture Medicus continues to stalk its prey, having spotted indicators on the nightly news. The stock market is highly volatile. Oil prices are creeping back up. Housing starts remain at long-time lows. Interest rates are down, meaning invested income earns less. Unemployment still is rising. Companies are delaying expansion. Truck and auto manufacturers are shutting down plants. Steel manufacturers are hurting and making joint deals with foreign competitors. To the Vulture Medicus, these signs are a call to hover. While the rest of society gives in or gives up, the Vulture Medicus is planning its move. Americans should take heed. The bones from its previous attack still are out there. They have been bleaching in the sun since the last recession and can not be ignored.

The Vulture Medicus remembers the early 1980s, recalling how companies fired hundreds of thousands of medically insured workers. Consumers came to its office less likely to accept the creature's suggestion to have some elective surgery done. This creature saw costs rise, but the number of patients remain static. So, it raised prices, making sure to keep its increases at least twice that of normal inflation. Why should Vulture Medicus have to alter its lifestyle? Vulture Medicus is smarter than steel workers, craftier than car salesmen, and more deserving of the good life than teachers or municipal workers. In the early 1980s, when many of these people put the word "former" before their occupational description, Vulture Medicus flourished. Its income rose. Hospitals were giving it bonuses to bring in more patients. The creature started its own laboratory, dispensed medication in its own office, maybe even bought a free-standing emergency center.

Life was so good that more Vulture Medicae were bred. In fact, the number hatched since 1980, compared to the growth of the general population, has caused most major metropolitan areas to be overrun by the species. Some experts argue that their numbers constitute as big a public health hazard as their pigeon relatives. Only a glut of Vulture Medicae can account for the creation of such medical specialties as sports gynecology or sports medicine.

The signs of another Vulture Medicus attack are emerging. They are complaining to the government about being overregulated. They carp about patients who can not afford to pay. They come on the radio or write to "Letters to the Editor" columns whining about the enormous increases in their cost of doing business. They have the unmitigated gall to acknowledge that they overtest and perform unnecessary surgery, all in the name of self-defense.

Women seem to be particularly prime pickings. Ornithologists may attribute this to the three-to-one ratio of male Vulture Medicae to the female variety. Whatever the reason, the facts are clear: The female human is the most obvious victim.

For instance, 25% of all babies born in America are delivered by Cesarian section. In 1970, only five percent of births were surgically assisted. England, with an 11.5% C-section rate, considers that number to be a national disgrace, brimming on scandal. The defensive medicine argument doesn't hold up in the C-section fiasco. In places where hospitals have made concerted efforts to monitor unnecessary C-sections, some rates have dropped by as much as 50%. Some insurers - the principal feed providers to the species - have started paying the subspecies Vulture Obstetricus the same amount whether the delivery was a natural one or a Cesarian. Figures on the effect of such financing changes show a drop in C-sections.

The examples of women as choice game are many. Experts suggest that more than half the hysterectomies performed are unnecessary. The number of tranquilizers prescribed to females are three times those doled out to males. Every month, more than 10,000 women are having artificial breast implants inserted under the skin of their chests. These implants - of which 30-40% later capsulate - finally have come under Food and Drug Administration scrutiny for safety reasons. Nevertheless, the sub-creature Vulture Cosmeticus Surgeonus rarely discloses the potential side effects of these less-than-medically-useful vanity devices to its quarry.

The human male is not immune as prey. Thirty percent of all coronary bypass operations, most of which are undergone by men, are considered unnecessary. Certain prostate procedures now are coming under suspicion as being performed inappropriately in many situations.

Even young members of the human species are caught in this apparent campaign of greed. Tonsils are being removed unnecessarily. Circumcisions are being performed when not medically or hygienically essential. Tubes are being placed in far more children's ears than clinically called for.

It is clear that, like their winged brothers, Vulture Medicae shows no mercy for their victims. Physician fees are rising at a 15% annual rate, even though normal inflation is less than six percent. Isn't this almost three-fold disparity another indication that Vulture Medicus is at it again?

Vulture Medicae are crafty old birds. They have worked hard over the years to develop a beautiful coat of feathers that covers an often ruthless personality. On the outside, most appear compassionate and kind, with a soothing coo, a pleasant facial demeanor, and a nest that offers comforting health literature and calming music. No finer aviary can be found than that of a successful Vulture Medicus.

Yet, beneath that surface of fine plumage often lurks a self-centered, hawk-like personality. Too many of the species are inconsiderate and uncaring. Some keep their prey stewing for hours on end, trapped in a chamber with other sick creatures. Their assistants, canaries in white, try to calm the soon-to-be-victim with phrases like "The Vulture has an emergency! While we're waiting, let's fill out some insurance forms," or "The Vulture is running behind. Just be patient." In reality, many merely are on the phone with another shrewd bird, plotting a business investment.

Studies of the Vulture Medicus report a changing bird. The education received from its elders is more technical than human. The Vulture Medicus has become so impersonal that many hospitals are using ink markers on patients before they are sent down to the surgical suite to avoid the Vulture Medicus performing the wrong procedure. All this transpires because the Vulture Medicus too often views its game as a condition, rather than a person. It is not unusual for a hospitalized patient to hear himself or herself referred to as the "gallbladder in room 405."

Collusion with hospitals

Hospitals are where the species loves to hang out since they provide a wealth of devices and equipment for its free use. It's a game that hospitals play in order to attract the best of the breed. Often, however, best of the breed doesn't equate to the best medical results. It merely may mean providing the largest amount to the bottom line. Indeed, the Vulture Medicus who admits the most patients or does the most high-volume, expensive procedures is treated like royalty. An entire hospital wing (no pun intended) may be dedicated to this pillar of the community.

Talon to talon, hospitals and Vulture Medicus work together. They often collude to keep important information out of the hands of the general public. Very few people are told what a hospital infection rate is. Hardly a soul knows how many medication errors a hospital makes in a day. When a member of the inner gaggle decides to squawk about an incompetent, fellow old coot, the species circles and goes right for the eyes, ears, nose, and throat of the bird with the loud caw. What results is a broken bird, with no referrals, less privileges, and few friends. Other birds see this and decide to keep closed-beaked forever.

There is no question that Vulture Medicus is a powerful creature, but there are signs that its strength is weakening. Since the middle 1960s, the species has lost many big battles. It started with Medicare, which the entire Medicus family opposed. They screeched that Medicare would be the demise of quality medical care. It was the first step to a "socialized" medical system and would hurt, rather than help, the public, they maintained.

As it turned out, Medicare proved a god-send to the Vulture Medicus. The program guaranteed that the often sickest members of society now would be able to pay for medical care. Not only did it mean that elderly Americans had access to medical services, it also signified that Vulture Medicus could give its charity to a place that could put its name on a plaque, rather than have to provide medical care to some poor elderly soul.

Of course, Vulture Medicus opposed health maintenance organizations. Such programs took the "peck-them-while-they're-down" fun out of medicine. HMOs meant Vulture Medicus would be paid a salary or a set fee that didn't reward unnecessary tests and procedures. That was a whole new tree to get used to, but Vulture Medicus has had to do so.

Today, Vulture Medicus continues trying to exert its power. The American Medical Association has offered its plan to assure full access to health care to all Americans. With 37,000,000 uninsured Americans, the Vulture Medicus has a lot at stake. Just think what life could be like if 37,000,000 more potential people were available for the picking. It makes even the nicest of birds sharpen its beak.

The victim of the vulture in the desert usually is helpless when the hovering begins. Nothing short of a miracle can save the wretched prey from the talons and beak of its predator. However, we do not have to be the victim of Vulture Medicae. We are not down nor are we helpless. We must ignore their cackling and take charge ourselves. Vulture Medicus is a family of predators that can be tamed in the marketplace, halls of state and Federal legislative bodies, and offices of the tax-paid public servants who oversee the rules and regulations that govern medicine.

All species of vulture hover only if there is a victim soon to be had. Without victims, the predator either must change its ways or die off. Our job is not to be a victim.

Mr. Inlander is president, People's Medical Society, Allentown, Pa., the nation's largest consumer advocacy organization.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Article Details
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Author:Inlander, Charles B.
Publication:USA Today (Magazine)
Date:Jul 1, 1993
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