Just how broken is the United States health care system? Dr. Otis Brawley, chief medical officer for the American Cancer Society, paints a grim picture in his new book “How We Do Harm: A Doctor Breaks Ranks About Being Sick In America’’(St. Martin’s Press).
If the title alone doesn’t clue you in, the reader quickly discovers that Dr. Brawley is determined to make everyone as uncomfortable as possible about the flaws, inconsistencies and inequities that are rampant in American medical care. The book, written with Paul Goldberg, a journalist, begins with a frightening tale of a poor woman who for so long went untreated for breast cancer that her whole breast literally falls off at home. She arrives at the hospital carrying it in a plastic bag, clinging to the naïve hope that it might be reattached. Dr. Brawley treated the woman at Grady Hospital in Atlanta, which happens to be the largest hospital in the United States, as well as the safety-net hospital for poor and uninsured patients in the area.
Dr. Brawley says it makes him furious when he hears “politicians and pundits” assert that American health care is the best in the world. The statement may be true for the rich, he says, but “it’s not a great place to be sick if you are poor and uninsured and want consistent, basic care.”
“I have seen enough to conclude that no incident of failure in American medicine should be dismissed as an aberration,” he writes. “Failure is the system.”
But as you nod your head in agreement, be warned that Dr. Brawley doesn’t place all the blame on insurance companies, hospitals and doctors. He also blames patients who have bought into the notion that more care — more treatment, more screening, more scans, more drugs — is better care. Many Americans, particularly wealthier ones, he says, are “gluttonous” in their consumption of health care resources and often use them unwisely.
I recently spoke with Dr. Brawley about the problems in American medicine, how both doctors and patients can be greedy and why he became such a “loudmouth.” Here’s our conversation.
I’ve seen that so many times, where doctors really have failed to evolve and failed to learn as the profession and the scientific evidence have changed over time.
I blame patients, I blame doctors, I blame hospitals, I blame drug companies, I blame insurance companies. Our health care system is messed up because the system is designed to fail, and everybody is responsible for health care failing as it is now.