Guarded Prognosis: A Doctor and his Patients Talk about Chronic Disease and How to Cope With It

Using his patients’ personal stories to illustrate dramatically how medical care once worked and how it works today, a concerned and caring physician makes clear just why he fears the current system has a very poor prognosis. Director of the Center for Women and Rheumatic Disease at the Hospital for Special Surgery in New York, Lockshin specializes in lupus, a chronic disease that affects every organ in the body and brings its patients into contact with all segments of the medical-care system. Drawing on some 35 years of medical experience, he writes knowingly and sympathetically of patients who need long-term, expensive care, whose problems may require speedy treatment by specialists. In doing so, he questions how well such individuals would fare in a system where primary-care doctors act not as their patients’ advocates but as gatekeepers, deciding who will have access to what kind of care. He acknowledges that cost is at the heart of the medical-care crisis, but points out that this cost comes largely from common, chronic, and crippling diseases. Lockshin outlines what he perceives as the elements of an ideal system and calls for a vigorous public debate over the issues, which, he notes, seem medical but are social and political as well. He argues that decision-making criteria concerning health-care resources and spending must include compassion as well as cost-benefit. The questions he raises about cost cutting, rationing of care, doctor-patient privacy, and individual needs and rights are ones that deserve careful consideration. An able spokesman for the poor and chronically ill, those whose voices he believes are seldom heard in the debate over health policy in this country, he has given us stories to remind us that abstract policies affect individuals who could be us or those we love. 

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