"Terrible Old Reactionary"

A successful surgeon with his own private practice is Professor Bertram Bernheim of Johns Hopkins. But he does not have much faith in the U. S. system of private medical care. He sees the public asking for more adequate, low-cost medical service, sees national health insurance coming, and he wants his colleagues to prepare for the future, lest laymen take over "the big business of medicine."

This week in a startling book, Medicine At the Crossroads,/- with a warp of drastic criticism and a moderate woof of diplomacy, Dr. Bernheim ripped into the medical profession. Considering himself a "terrible old reactionary," he offered plans for medicine's modernization. Among his suggestions:

Surgery. Americans, says Dr. Bernheim, are "hellbent for surgery" because it is dramatic and thorough. Although there are hundreds of outstanding surgeons who never rush into an operation, "too much surgery is done." Reason: Surgery "is easy money--it comes quick and there's lots of it." While family physicians, who suggest operations, are paid very small fees, "the surgeon is the big shot--and big shots cop the coin." Too often the only money a physician gets from an operation is an unethical "cut" the surgeon hands him for bringing in a patient (fee-splitting).

To protect patients from greedy surgeons, Dr. Bernheim suggests a major operation: "cut out the surgeon--eliminate him entirely from private practice." All surgeons, he believes, should have their offices in hospitals and should receive salaries from hospitals. Patients should choose their hospitals, but leave the choice of their surgeon up to the chief of staff. This system is practiced in the "justly famous" Mayo Clinic. If it were put into general operation, says Dr. Bernheim, surgeons would become more highly specialized and hospitals would weed out inefficient men. Of course, "surgeons won't like it ... but men ought not to want to make great sums of money . . . for cutting into human flesh."

Horse & Buggy Practice. So rapid has been the scientific progress of medicine that a great number of physicians are practicing "horse and buggy" medicine according to the rules of the past generation at the expense of "the defenceless sick." Dr. Bernheim's remedy: medical licenses should be granted not for life but for periods of five years. This would allow young graduates a five-year trial period in which to find themselves, would make it necessary for specialists to secure separate licenses to work in their chosen fields. Since they would have to take periodical examinations, doctors would find it fatal to neglect postgraduate study.

Eventually, thinks Dr. Bernheim, all doctors will band together and practice in clinics, and this streamlined system of medical care will in itself bring greater specialization and raise the quality of service. Once this great step is taken, he believes it will make little difference in a doctor's professional life whether the patient or the government pays the doctor's bill.

/- Morrow ($2.50).

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