Skip to main content

Bedtime story

Once upon a time there was a big country with not very many people living in it. They were farmers, and ranchers and teachers and people who sold things that other people needed. There were doctors, too, who gave advice to the sick, did minor surgery and comforted the dying. The doctors could set bones, bandage wounds and tell people approximately what was wrong with them, but they couldn't do much to fix people who were sick. Eventually the doctors made schools to teach each other what they knew, and educate new doctors who would know a bunch of things right off, rather than having to learn them as they went along. The new well educated doctors were respected because they were able to help people who really needed help, so smart young people wanted to be doctors. In the medical schools the teaching doctors were able to discover new ways to treat the dread diseases that they saw, and so the job of doctoring was associated with more respect. With the respect came good pay. When doctors were actually able to do something for patients the patients were more willing to pay good money for what the doctors had to offer.

Pretty soon the only people who could get into the medical schools to become doctors were the smartest students, and they were often from rich or influential families. A job with good pay and immense respect was hard to beat, so qualifying for it became very competitive. The prospective doctors didn't realize, though, how hard it would be to learn the increasingly huge amount of book facts and practical skills that were taught at the medical schools. The time and effort that were spent educating these students was huge as well, and so the cost of going to these medical schools rose. The young doctors, despite their good families, often were not able to pay for school and went into debt and they were sometimes ill or sad because of how hard they studied.

The ever more effective and fancy procedures that the young doctors learned were very expensive, but they were also the only thing that might stand between a sick and suffering person and death. There was no question. The sick and suffering person had to have them. Since the procedures were so expensive, nobody could really afford to pay for them. Cleverly, the communities of people produced a whole industry that would pay for the medical procedures that people couldn't pay for themselves, using money that was contributed by everybody, even when they weren't sick.

The doctors became more powerful, as a profession. In order to make them accountable to their patients, the communities of people hired lawyers to tell them when they had done wrong, and the lawyers told the doctors that if they didn't behave, they would have to pay lots and lots of money. The doctors then started doing more and more for the sick and not so sick people so that the people would like them and not sic the lawyers on them. But the more things the doctors did to make the people happy, the more money the people spent and eventually all the money in this entire country was spent on the stuff that the doctors did, and there was no money to spend on other things the people needed.

A wise matriarch who lived on top of a mountain saw that the whole thing had gotten utterly and ruinously messed up, and so she did something that was so wise and so creative that all of the happy people who lived in that country spoke of it around their kitchen tables of an evening, for long generations. But I'm not entirely sure what she did. We can, though, write the rest of the story any way we like, so long as the ending comes out happy.

Comments

Popular posts from this blog

How to make your own ultrasound gel (which is also sterile and edible and environmentally friendly) **UPDATED--NEW RECIPE**

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel. Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glyce

Ivermectin for Covid--Does it work? We don't know.

  Lately there has been quite a heated controversy about whether to use ivermectin for Covid-19.  The FDA , a US federal agency responsible for providing unbiased information to protect people from harmful drugs, foods, even tobacco products, has said that there is not good evidence of ivermectin's safety and effectiveness in treating Covid 19, and that just about sums up what we truly know about ivermectin in the context of Covid. The CDC, Centers for Disease Control, a branch of the department of Health and Human Services, tasked with preventing and treating disease and injury, also recently warned  people not to use ivermectin to treat Covid outside of actual clinical trials. Certain highly qualified physicians, including ones who practice critical care medicine and manage many patients with severe Covid infections in the intensive care unit vocally support the use of ivermectin to treat Covid and have published dosing schedules and reviews of the literature supporting it for tr

Old Fangak, South Sudan--Bedside Ultrasound and other stuff

I just got back from a couple of weeks in Old Fangak, a community of people living by the Zaraf River in South Sudan. It's normally a small community, with an open market and people who live by raising cows, trading on the river, fishing and gardening. Now there are tens of thousands of people there, still displaced from their homes by the civil war which has gone on intermittently for decades. There are even more people now than there were last year. There is a hospital in Old Fangak, which is run by Jill Seaman, one of the founders of Sudan Medical relief and a fierce advocate for treatment of various horrible and neglected tropical diseases, along with some very skilled and committed local clinical officers and nurses and a contingent of doctors, nurses and support staff from Medecins Sans Frontieres (Doctors Without Borders, also known as MSF) who have been helping out for a little over a year. The hospital attempts to do a lot with a little, and treats all who present ther