My Dinner Conversation

The Place and Time: Lyon, May 2010
Setting: Dinner Meeting at Brassier Nord, a Michelin star chef's local digs
Players: Neurosurgeons from France, England, German, and me (USA)
Theme: Medical systems: What works and doesn't
(Preliminary Info: All sitting at the table are pretty tops in field)

On a recent lecture tour in France, I sat back and listened to a remarkable discussion revealing the mixed assessments of physicians of mixed how successful their own medical delivery system worked-for both themselves (physicians) and themselves (patients).  Highlights:

Germany: Two tiered system.  Everyone must have insurance, responsibility is on individual (not employee), if you can't pay you get it anyhow, and if you earn enough you can opt out and get "private insurance."  Biggest catch for patient:  Once you opt for private, there is no going back!  Biggest catch physician: Little motivation for innovation, working hard, etc when on straight salary.

France:  Subtle two tiered system, everyone insured by state, private insurance allowed for upgraded service.  Increasing numbers opt private leaving the public system in tailspin.  Biggest perceived challenge: "fraternity" not fair that some have better than others! For doctors-the allure of the dollar is strong so they would rather spend their time in the private sector.

UK: Once the quintessential socialized system, now two-tiered and highly regulated.  Also crunched by work hour restrictions on house staff resulting in both workforce and competency issues.  Patient challenge:  wait times.  Physician challenge: highly regulated and little opportunity for creativity.  Leading edge of outcomes/quality assessment that I've encountered.

The US is entering a period of transition for our medical system.  There is so much propaganda flying around about the failings of other systems.  This dinner conversation proved many important things to me.  First, certainly no medical delivery system is perfect and effecting positive change in any system is excruciatingly slow.  Delivery of medicine is ever more complex, time consuming and less remunerative for physicians.  However, no one will argue that maintaining the status quo is just not a viable option.

Another Positive Review

Frances Conley, M.D.

Frances Conley, M.D., who wrote an award winning book Walking Out on the Boys, reviewed Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do in the Journal of Neurosurgery, May 2010. Dr. Conley was one of the first women neurosurgeons in the US ( details here and here) so I knew she would pull no punches, especially given her own literary (in addition to professional) success.  So I was thrilled by her overwhelmingly positive review.  She even challenged us to write Volume II in another 20 years!  Thank you Fran for all your positive words-they mean so much to me that you enjoyed our efforts.

Travel and Work

Flew to Paris and before I could say Bon Jour
Off to Lyon, speeding away from that magical place
Arrived safe.

Checked in, nosed around, all around
First in the center then spreading further away
To see it!

Wild views, what food, much history
You're not in Kansas anymore
But happy.

Delivered talk, all new material compiled
Precipitated chatter, so deemed success
Time for home.