A retired Mayo Clinic physician's last literary hurrah
Dr. Richard DeRemee's book of essays focuses on the medical system and the physician's loss of autonomy.
ROCHESTER — Retired Mayo Clinic Dr. Richard DeRemee calls it his swan song.
Through his 30-year career at Mayo Clinic and well into retirement, DeRemee has been a creative writer. At 89, DeRemee says there are times when his muse walks off, but then it slowly returns.
He calls his latest book a “distillation” of his writing career. ”Because of my age, it is about to come to an end.” DeRemee lives with his wife, Lucy, at Homestead Retirement Community.
“It is kind of an elegy,” he said of his book.
The book, “Collectio Scripturae Inedita,” which is Latin for “Collection of Unpublished Writing,” includes short stories and poems, anecdotes on famous people and ruminations on Quantum mechanics. A glancing interaction he and his wife had in a German airport with hostages who had escaped Iran is one of the more intriguing narratives.
But his spiciest piece are his thoughts on the American health care system: Physicians, he says, have been the most impacted over the long haul. Once independent operators and solo practitioners, they have become “mere employees who take orders from administrators.”
From the bureaucratization of health care to a public conditioned to believe through advertising that it lives on a precipice between health, on the one hand, and disease and death, on the other, DeRemee sees an ineluctable trend toward socialized medicine – two words that stirred horror in physicians when he first entered medicine.
One time, DeRemee was invited to a luncheon attended by 26 Nobel Prize Laureates at his alma mater, Gustavus Adolphus College.
There, DeRemee found himself seated next to Linus Pauling, a two-time Nobel Medal winner, one in chemistry for his work on chemical bonds and the second the Peace Prize for his opposition to nuclear weapons.
But on this day, Pauling scolded DeRemee for his noxious smoking habit.
Noting the irony of a physician who indulged in such a deadly habit, Pauling proceeded to work out the calculations on a linen napkin of how much life DeRemee was robbing himself of from smoking. “With a look of triumph,” Pauling revealed his calculations, estimating that DeRemee lost 16 minutes of life for every cigarette he smoked.
On Jan. 28, 1980, DeRemee and his wife were preparing for a flight from Munich back to the states. But at the terminal, they learned that their flight had been altered and delayed. Then, at one point, a group of six were rushed down the boarding ramp and general boarding began.
DeRemee and his wife sat in different sections of the plane. One of the six who sat next to Lucy remained mute the whole time. After arriving at Frankfurt airport, an addition to their revised flight plan, the six were escorted off the plane, surrounded by a phalanx of German military vehicles. The next day, the news was filled with stories of the escape of six American diplomats from Iran. The story was later dramatized in the movie, “Argo,” produced by and starring Ben Affleck.
But it is DeRemee’s controversial take on the U.S. health care system that for many may make the most interesting reading.
Within DeRemee’s own three-decade career, he has seen the role of physicians change from independent operators to professionals progressively circumscribed by parameters set by administrators. Physicians are more technicians than professionals. It is hard to imagine a health care bureaucrat or physician publicly making the same critique.
“I was raised in an era where socialized medicine was the worst thing that happened to mankind, and I bought that line,” DeRemee said in an interview with the PB. “As I see it, medicine has surrendered itself to bureaucracy. Doctors are no longer free agents, and they’re led by administrators.”
Much of the reshaping of medicine has been driven by economics. Advertising, the bottom-line focus on profit, unrealistic public expectations about what medicine can do, the role of technology and the specialization of medicine have all contributed to its rising costs.
Advertising, he says, has been a pernicious trend in health care. At one time, advertising was restricted. Antitrust litigation eventually upended that proscription. The free-for-all in advertising has not had a positive effect.
“It has not decreased costs and, moreover, has put undue pressure on physicians by patients responding to advertising for certain drugs or treatments,” he writes in his essay. “Advertising has perverted the goals of medicine by diverting substantial funds away from care to image-making.”
Efforts to contain costs have restricted physicians’ freedom of practice, not only in the performance of laboratory tests but in determining the length of hospital stays and the medications a patient can take, he says.
The environment has led to the growing prominence of physician assistants (PAs) and nurse practitioners.
“They are not unlike corpsmen in the military. There are pitfalls, however, in this practice that can be dangerous and costly,” he writes. “Physician assistants, nurse practitioners or similarly trained technicians can be a barrier to good care, because they divert and dilute responsibility and blur the interface between patient and physician.”
He said many officials directly involved in building medical facilities pay lip-service to containing costs, but their actions belie the rhetoric.
“It seems a hospital is not considered in the modern age if it does not have its own helicopter,” he writes.
Part of the problem, he says, is rooted in public attitudes about the role of medicine. The system is overused if not abused. One only needs to visit a typical American emergency room to recognize the reality.
“Gone is the common sense of dressing a minor wound or scratch or treating a common cold,” DeRemee writes. “It is as though all responsibility for illness, no matter how common or trivial, has shifted totally to the medical establishment.”
DeRemee writes that the question is not about returning to a Golden Age of medicine, but rather making the best of a difficult situation.
A growing federalized system will likely result in a wasteful bureaucracy, a reduction of funding to levels that will discourage innovation and research, a rationing of certain procedures and treatments for patients based on age and further decline in physicians' autonomy and stature.
But there may be no other choice.
“The final solution probably lies in a comprehensive federally financed system that gives access to all,” he writes. “Given all the faults and injustices of the current potpourri of programs, it appears there is nowhere else to go.”