Oh, and husband, father to four girls, brother to three female siblings, free family medical information resource. Ice skater, fisherman (in lakes and streams overblown by the recent train wreck a few counties away over the state line.

I think Topol’s targets are a start. More power to him and Hopkins. There are efforts underway to extend online accessibility, so telemedicine can help for some parts of ‘care.’ I agree with Topol that there is a lot of human touch that has to be dug out of the clerical overload

So both patients and various caregivers are frustrated, exhausted, distracted. Patients don’t see the background moving parts—unless they have to fight with some part of the system. Caregivers just have to keep going.

Topol observes that ‘medical gravitas’ is necessary to face down all this (and drug industry complexity issues, which I didn’t grow up with & can’t speak to). Topol also observes that the AHA (American Hospital Association) is in his view the most powerful lobby—note: not the AMA

So where will the gravitas come from? Doctors, as you observed, differ. (Witness the difference over COVID. And go look at differences over cigarette smoking back in the 60s before a Surgeon General took a stand.

Medicine is an art. Those differences (e.g., re COVID and cigarettes) sometimes reflect more than just CSS skins; sometimes the difference is the equivalent of differences in the bare text.

My sister, dentist, was very conflicted about the increasing number of her patients covered by a medical insurance company that was low bidder, but also covered less. Management makes that decision for some groups, say State Police for instance. I said, doesn’t the ADA help?

She said that the ADA hasn’t had the clout necessary to sort things like that out for years. Same with the AMA for medical care.

There’s one more thread I should call out: malpractice insurance. It addressed a need, but then it became specialized. General practitioners couldn’t insure themselves for all the baby deliveries (gynecology), broken-bone setting (orthopedics), sprains (sports medicine)…

So now we have the gate-keeper specialty: family medicine. And emergency medicine arose when my dad had to have malpractice insurance per some requirement. He wanted to serve people in real need, he said, so he got ACLS/ATLS certified and chose emergency medicine.