In Tom Brokaw's book "The Greatest Generation", he chronicles the the life of Dr. Charles Van Gorder. The good doctor participated in the D-Day Normandy invasion armed with a tent, medical supplies and a knowledge of surgery. His theatre of practice was the field of combat. Van Gorder had enlisted in the Army, served in North Africa as a combat surgeon, then was sent to the greater ferocity of combat on Normandy beach. The Germans, attempting to expand a fledgling empire, had a far different intensity in North Africa than when they made a last ditch to save their homeland and a dream of dominance in 1944. Van Gorder's efforts were in the embryonic field hospital later to be named field hospital/MASH unit. He was literally under fire while operating.
After the war Van Gorder returned to the U.S. to practice medicine in the small town of Andrews, North Carolina. He and a colleague, who fought the D-Day invasion in the same battlefield hospital as Van Gorder, opened the only medical practice in the town and also founded the first and only hospital there. After his retirement Van Gorder told Brokaw,refering to his life. " If I had my life to do all over again, I'd do it the same way. Go somewhere people have a need, contribute something to people who need it;help people."
Dr. Van Gorder and thousands more like him carried on and refined the "house call" in the medical profession. Those self same "thousands" built many rural hospitals and treated many rural families over their careers. These were the Lion's Club officers, the Rotarians, the Sunday School teachers of the generation of parents that gave birth to the baby boomers. They fought on D-Day and elsewhere on the planet, then came home to live and serve.
How will that ethic be affected if each step of the treatment process becomes a matter of regulation and not instinct? How will the medical profession attract people like Dr. Van Gorder if service involves sticking with a script? Work ethic is internal to the individual. Dedication flows from the individual through the sense of ownership of the outcome, availability of self determination. The first doctor that visited a patient at home did so in the name of taking the initiative to treat the patient. It was his decision to treat the patient that way. In today's world, the housecall is a dinosaur without a fossil record.
As we sail headlong in to some version of government controlled healthcare, costing some version of dozens of cost estimates let's take a moment to wonder aloud. How will this affect the character and structure of the profession that attracted Dr. Van Gorder and his contemporaries? Governing implies control, the authority to make decisions. Government is the sum total of enabling rules and those people designated to carry out the rules. Somewhere in all this governing is always one fallible human who has to make one of many final decisions that affect the citizens.
Is it better to have health care, the service provided and its resulting cost, governed by the fallible human being(s) who is/are "hired" or appointed, or the market place where all citizens vote with their pocket book and feet? Will the future Van Gorders be enthusiastic serving in a government system or a marketplace? Will those same Van Gorders be dedicated to the "system" and its rules for as long as they would be dedicated to the self determined treatment of the patient have the option of sitting with, talking to, and getting to know as a patient?
