Doctor shares perspective of changes in medicine with students

Despite many positive advances over the past twenty years, internal medicine specialist Dr. Bryan Cotton of Lubbock said the state of medicine has seen its share of negative hits as well.

In an address to the Third Annual Medical and Health Careers Fair held Friday, Nov. 9 at Wayland Baptist University, Cotton gave his own perspective of how healthcare has changed since he has been practicing, specifically in the past two decades.

"Technology has made a huge difference," he said. "It's given us abilities we couldn't even dream of 20 years ago."

Among the technological advances, Cotton mentioned chemical markers that help indicate diseases or injury earlier and new tests that help detect and treat cancer. He also said advances in genetics and the ability to check early for presence of diseases was a positive step, though it presented a sticky situation in the area of ethics as far as replacing genes to correct deformities.

Other advances Cotton noted were in the area of imaging, including the CAT scan, MRI and improvements in ultrasound, and in flexible endoscopy, which allows for detection and surgical procedures with minimal cutting and recovery time.

But even with those positives, Cotton said the negative changes in medicine weigh heavily in the equation. Among those are litigation, third-party insurance and patient's rights.

"When I started, it was unheard of for patients to sue physicians. We were gods and they were mere humans," Cotton joked. "This has had an impact on the economy of medicine, because many doctors will do defensive testing on a patient just to make sure he won't get sued."

He also said litigation has raised medical costs, since doctors, hospitals and insurance companies now must carry expensive malpractice insurance and those costs get passed down.

Third-party insurance - including health maintenance organizations (HMOs) and Medicare - has affected medicine negatively in three ways, Cotton said. For one, the tightening rules and regulations mean physicians often must ask permission to perform procedures on patients. Those organizations also hold great control, Cotton said, since they frequently have blocks of a doctor's patients and can use that as a manipulation to hold to higher discounts. The interference with procedures, however, such as when a company tells a physician he cannot perform a procedure because the patient is not covered for such costs, is most disturbing to Cotton.

"Something really needs to be done, because you have people without a medical license practicing medicine, basically," he said.

Cotton said patient's rights have meant doctors have to keep up with many different sources of medical information, especially that on the Internet, in order to know what patients are taking in.

"People used to come in and say, 'Doc, please help me,' " he said. "Now they say, 'I have spent 12 hours researching this and I have such-and-such and want this test done and this prescription.' I wish that were funny but it's not. If I did all that, I wouldn't be a doctor, I'd be a clerk."

Cotton also noted several societal changes have affected medical practices, namely in the area of morality and issues of life and death such as abortion and euthanasia. He also said many medical schools are forgoing the traditional reciting of the Hippocratic Oath, a trend which disturbs Cotton.

"What I see in the long-term perspective is that when you make the physician not a healer but a killer, you've changed something drastically about medicine," he said. "What we're seeing is a fight for the soul of medicine, if you will."

Despite all this, Cotton still encouraged students who wanted a life of service to consider medicine.

"Medicine is an incredible career. You can really make a difference in someone's life," he said. "You shouldn't go into medicine if you look at it as a career or a way to make good money, but only if you have a calling."

A semi-retired specialist, Cotton served as a doctor in the U.S. Air Force before going into private practice in Corsicana, Clovis, NM, and Lubbock. Wayland's annual Medical and Health Career Fair offered high school and college students a chance to visit with and get information from representatives from area professional schools and medical programs, including medical and dental schools, nursing, physical therapy, radiologic technology and dental hygiene.