by C. Richard Patterson, MD


I recently posted “The Five Worst Things in Healthcare”, an admittedly idiosyncratic view of our circumstances. It’s only fair that I make a counter list; it was harder than I thought it would be.

1. The People

Healthcare is about people, obviously: human biology, its flaws and remedies. In this list the people to whom I refer are commonly called “caregivers”, a term I consider treacly to the point of icky, but which does aptly describe what they do. Despite dark declamations from some of the more curmudgeonly among my generation, healthcare continues to attract bright, eager, hard-working, and committed young people to the ranks of doctors, nurses, lab and radiology techs, EMT and, yes, business management. There are shortages to be sure, but those who continue to step up, to endure the long training, to care for those who may or may not be grateful are a splendid group and a pleasure to be around.

2. We’re Spending Too Much on Healthcare

How is this a good thing? It beats the heck out of not spending enough because you don’t have enough. We’ll kick in around three trillion this year in healthcare, about one third of which is widely considered wasted. I’d much rather be looking for efficiencies than for additional revenues. Of course, as others have noted, one person’s waste is another person’s income. I’m not saying creating efficiencies will be easy, and I am not sanguine about its being done well at the federal level, but it still beats empty pockets.

3. Whiz Bang Technology

You may point out that Princeton’s Uwe Reinhardt, among others, has declared our expensive technology as a major driver in our over-spending on healthcare. I’m not equipped to debate the economists on this. I can tell you, however, that I accompanied my surgery professors to the radiology department to see an attempted abdominal scan with a first generation CT that was designed for heads only. I mimicked their chortling and scoffing. By mid-career, I was performing operations that I would not have otherwise considered because I had the advantage of exquisite imaging. We also denigrated the nascent fields of interventional radiology and minimally invasive surgery…right up to the point that we became dependent upon and very grateful for them. Never bet against the engineers, including the genetic ones.

4. Our Healthcare System is in Turmoil

This could have made either the “best” or “worst” list. I place it here because, unfortunately, I have long been convinced that only impending calamity would spur meaningful action. As painful, nasty and ugly as it is likely to be, this purgatory is probably necessary if we are finally to pursue a mature and collaborative course toward a more sustainable system. The demand for healthcare will always be with us. We must find a way to supply and finance it that will not impoverish our nation.

5. The Internet

For most of my career, I went to considerable effort and expense to maintain a current library of textbooks, journals, and other hardcopy sources. Today, I sit before a keyboard or my iPhone and pull up more information than I could have accessed in days of roaming the stacks. That information is available to everyone. There is also misinformation, but so there was in traditional print. The internet is also facilitating the exchange of ideas, opening a forum hitherto unavailable to hacks like me. While our contributions may not qualify as undying prose, while some or all of our ideas may be half-baked, there is yet value in the dialogue and provocation of thought, concurrence or dissent.

This concludes my companion piece to “The Five Worst Things in Healthcare”. You almost certainly have your own list, and I’d like to read it.

Happy New Year.