The Sunshine Enema

The sunshine enema is not something advertised in your spam email inbox. It's quite different. You may have already had one, without noticing.

I was introduced to the sunshine enema, early in my practice, when physicians would send newly diagnosed patients with cancer or leukemia (or sometimes walk down the hall with their arms around their shoulders) to introduce them to me. The physician usually said something like this: this is Dr. Kaplan who specializes in taking care of people with your illness. He will be taking good care of you and you will soon be feeling much better. You won't need to see me any more because he is now your doctor. If your family has any questions, have them call the good Dr. Kaplan.

Lest you think this was a complement to me, be assured, it wasn't. It was a way to avoid the truth, shift professional responsibility to someone else, and to deceive the patient and his/her family, giving them the illusion that their usual doctor was honest and open. In fact, the usual doctor often hadn't even told the patient the grim diagnosis.

No one talks about the potential for "pay for performance" to cause physicians and other health professionals to cherry pick their patients and to send many of them on to other professionals "who specialize in taking care of people with your illness" rather than bear the professional responsibility, potential financial risk, and likelihood of being labeled as less than expert under the new system. Particularly if you, or a family member, has a rare, difficult to treat, or potentially very serious illness you may find yourself cherry picked right of your customary doctors' offices and into the hands of a new set of professionals who represent the new dumping ground.

When our political candidates tell us that they have a fix for what is ailing the health system, and paint glowing pictures of the bright new world ahead, they are giving us all "the sunshine enema." And it doesn't cause us a moment's discomfort - yet.