|Dr. X Visits Dr. Rogers' Neighborhood|
|Dr. X Visits Dr. Rogers' Neighborhood
Scene: The utility room in Dr. Rogers' office. Dr. Rogers enters right. He is dressed for winter and brushes the snow from the shoulders of his winter coat and stomps the snow from his boots. He is alternately humming and singing words from the Dr. Rogers theme song. He walks left to the closet and exchanges his coat and boots for a long white lab coat and loafers. He adjusts his pocket protector and straightens the pens and pencils. He faces the camera and smiles gently..
Dr. Rogers: Good morning boys and girls. It's so nice that you could visit me this snowy morning. I love the snow, don't you? Today we have a little surprise for you. Our old friend Dr. X is planning to come by and (Dr. Rogers glances at his watch) he should be here any minute (knock on door right) I'll bet that's him now. (Dr. Rogers turns to the door and opens it. Dr. X enters. Dr. X's face is obscured by an electronic image distorter and his voice has been electronically disguised.)
Dr. Rogers: Good Morning Dr. X, how kind of you to join us this snowy morning. Here, let me take your hat and coat.
Dr. X: Good morning, Dr. Rogers, thank you for inviting me to your office. Good morning, boys and girls. Dr. Rogers, I've wanted to visit you for a long time just to see for myself how a modern medical office like yours works. I know that things have changed a little bit since we both started practice (both doctors share a knowing laugh)
Dr. Rogers: Well yes, it certainly has.
Dr. X: and I thought it would be nice if the boys and girls could see for themselves what the practice of medicine is like in today's corporate world. That way when they get sick they won't be frightened because they know that good doctors like you are there to make them well again.
Dr. Rogers: Yes, you're right Dr. X. My goodness, how things have changed since Mr. and Ms. Businessperson and Mr. and Ms. Government came to help us. As you know we used to spend way too much money taking care of our patients and Mr. and Ms. Businessperson and Mr. and Ms. Government had to show us how to help our patients more economically. Why, we'd all be in the poorhouse if they hadn't come to our rescue. Let's go take a look.
Dr. Rogers leads Dr. X down a long corridor. He opens the first door on the left.
Dr. Rogers: This is my waiting room, Dr. X. Boys and girls, can you say "WAITING ROOM?"
(Camera moves into large waiting room filled to SRO with young and old in various stages of distress. One man is convulsing on the floor. Another man sits in the corner, vomiting bright red blood into a bucket. A very pregnant young lady appears to be in labor.)
Dr. Rogers: These are our nice patients, boys and girls. They've come here so that I can help them feel good again.
(Nurse Sally enters hurriedly from the right.)
Dr. Rogers: Why, good morning, Nurse Sally, how are you this snowy morning?
Nurse: Good morning, Dr. Rogers. I'm fine, thank you. (Turns, smiles) Dr. X, it's so nice of you to visit us. (Turns back to Dr. Rogers. The smile fades.) I'm sorry doctor Rogers, but I have to warn you about your schedule today. You asked us to keep your schedule light for the TV show, so we scheduled only thirty patients, but with the bad weather we'll probably have at least a dozen walk-ins. There is also that couple that came in last night after you left. We had to put them in sleeping bags here overnight. It would be nice to see them first, but Mrs. Hildebrand is in room four, and I think you'll probably need to see her first. (Dr. Rogers turns to Dr. X, smiles and shrugs his shoulders with happy
Mr. Rogers: Well Dr. X, maybe you and I should get to work. (He waves to the camera) Come on boys and girls follow us.
(They walk into a small exam room on the right. An elderly woman lies on the exam table. She is unresponsive and her breathing is agonal. Several family members look up anxiously as the doctors enter.)
Dr. Rogers: (to the comatose patient) Good morning, Mrs. Hildebrand, how are you today? (He turns to the family, smiling) I'd like you all to meet Dr. X. He'll be helping me today. Well, she really looks so much better than she did last week, doesn't she? Was she able to take those antibiotic pills that I prescribed?
Family Member: Well, not exactly, doctor. The pharmacist had to give us a different antibiotic because the one you prescribed wasn't on her insurance company's formulary. The pharmacist said the one he gave us would probably work just as well, but you can see that it hasn't done much. In fact, she hasn't opened her eyes in two days and she started that funny breathing this morning. Doctor, we hate to bring this up again, you're the doctor and we know that the doctor knows best, but don't you think she's sick enough now that we could put her in the hospital?
Dr. Rogers: No, no I certainly don't think she's sick enough to warrant hospitalization. In fact, she looks a lot better to me today. Not coughing and vomiting like she was last week. I'll prescribe this suppository. (He starts writing the prescription. At the same time, Mrs. Hildebrand stops breathing. The family members see this and try to get Dr. Rogers' attention. He is, however, too busy writing out the prescription.) That way you won't have to worry whether she's conscious or not. You should give this to her four times a day. We'll see her back here next week. Schedule with Helen at the front desk on your way out. Have a nice day. (Dr. Rodgers tears off the prescription, and slaps it onto Mrs. Hildebrand's chest. As if shocked, the old lady's eyes pop open, she takes a huge breath, and springs into a sitting position.) See, she's doing better already. (He turns and walks out the door as Mrs. Hildebrand falls lifelessly back onto the table.)
(Scene changes to hallway. Dr. X. and Dr. Rogers in foreground.)
Dr. Rogers: Too bad about that antibiotic I prescribed. Well, it was probably just too expensive. (He shakes his head sadly) And hospitalize, hospitalize! That's really all people want these days. They just don't understand that today we can do as much outside the hospital as we did in the hospital ten years ago. Besides, no person in their right mind would want to go into a hospital when they can stay in their own home, in a familiar environment, surrounded by loved ones. You may not have known that either, boys and girls. But now you do, don't you?
(Behind the two doctors the Hildebrand family is crossing the hall from the exam room right to the waiting room left. A limp Mrs. Hildebrand is being carried over the shoulder of one of the men.)
Dr. X: Not to mention the needless expense of hospitalization.
Dr. Rogers: Yes, there's that, too. And, of course, Mr. and Ms. Businessperson have given us some terrific incentives to make sure that we practice medicine economically. For example, some of our insurance companies provide us with an arrangement called capitation. Say CAPITATION, boys and girls. Capitation is a way of paying for health care by giving the doctors a single lump sum of money from which they take both their own salary and the cost of their patient's care. That way if the doctors spend too much money on their patients they don't have any money left over to pay themselves. Or, if they don't spend very much on their patients, then they have a lot left over for themselves.
Doctor X: That arrangement certainly makes good sense.
Dr. Rogers: Another wonderful incentive that Mr.and Ms. Businessperson have given us is the risk pool. Say RISK POOL, boys and girls. Just imagine a swimming pool with a few sharks in it. (He laughs at his own joke.) So you have to be a little careful. But you can still have fun. In the risk pool, the insurance company pays the doctor for seeing their patients but the insurance company holds back some of the doctors' pay. Then, at the end of the year, if the insurance company thinks that the doctors have spent too much money taking care of the patients, then the insurance company can take the doctor's money. At first it sounds bad, but these little inducements can help doctors find the right balance between how much money they make and how much they do to help their patients. And, of course, if it is all done right then Mr. and Ms. Businessperson are able to make a little money for
(Dr. Rogers stops in mid-sentence and cups his hand to his ear. A smile spreads across his face as the roar of a jet airplane becomes clearly audible, then deafening, and finally disappears off into the distance.)
Dr. Rogers: Boys and Girls, did you hear that? That was Mr. CEO flying off in his private jet to his home in the Bahamas. I hear it has three swimming pools and two tennis courts. My! We did such a good job for him last year! I've heard that he's very happy with us. Mr. CEO works so hard to keep us from wasting money that he deserves all the little toys that we can provide him with. I've actually never met him. In fact, I don't even know what he looks like, but I hear he's a very good businessman. And after all, medical care is just a product like everything else. Isn't it? Say PRODUCT, boys and girls. Well, Dr. X, let's see what we have in Room three.
(Dr. Rogers and Dr. X walk down the hall, open a door to the right and encounter a sad-eyed little boy sitting on the exam table. Dr. Rogers smiles.)
Dr. Rogers:Timmy, it's so nice to see you again. (Dr. Rogers suddenly looks confused, picks up Timmy's chart, and leafs quickly through it. He looks back at Timmy.) But why are you here? I thought you were going to the Big University to get that special treatment that I told you about. What happened? Did you and mom and dad decide against it? (He looks around the room.) And where are mom and dad? Are they sick?
Timmy: No, they're OK, Dr. Rogers. They're just in court. My aunt dropped me off so I could say goodbye to you.
Dr. Rogers: Say goodbye? I don't understand, Timmy. What do you mean?
Timmy: Our insurance company said that the treatment you told us about was experimental and they won't pay for anything experimental. Mom and dad didn't like that and they got mad and hired a lawyer but the insurance company still said no. So now mom and dad have a lawyer but he's so busy that he's not going to be able to go to court for a few months and by that time and by that time I'll probably be in heaven. And I guess that's OK, but I don't know what heaven is going to be like. Do you know what heaven is like, Dr. Rogers?
Dr. Rogers: (stunned) The insurance company won't pay for your treatment?
Timmy: No, not yet anyway. I'm sorry, 'cause I know how much you wanted me to have that treatment. You were real happy when you told us about it.
Dr. Rogers: (collecting himself, and kneeling before Timmy.) Well, Timmy, heaven is a great place. They have lots of baseball fields, and soccer fields, and if it rains they have basketball courts and you can watch all the TV you want.
Timmy: Do they have cable?
Dr. Rogers: Even better. They don't need cable. You've so high up in the sky that you can get any channel you want. Any time. (He stands.) Well, Timmy, Dr. X and I have to go see some other boy and girls who are sick. I hope your lawyer get it worked out so you can get that treatment. Say hello to your mom and dad and if your lawyer wants me to write a letter, I certainly will.
Timmy: Thanks, Dr. Rogers. Thanks for trying to help me. (Dr. Rogers and Dr. X walk wordlessly out of the exam room into the hallway. A long pause)
Dr. X: Bummer!
(Dr. Rogers doesn't answer. He stands unmoving as if he has lost all contact with the world. Nurse Sally walks quickly to the two Doctors. Dr. Rogers is so lost in his own thoughts that the nurse must put her hand on his arm and squeeze it to get his attention.)
Nurse Sally: Dr. Rogers, the children and their parents are all assembled in the conference room. It would be a good time to make your appearance.
Dr. Rogers: (slowly) Of course, thanks, Sally. Thanks for reminding me. Dr. X, I'm sorry that you and all the boys and girls had to see poor Timmy. It breaks my heart when kids don't get the treatment they need, even if the chances are small that it would help. (He pauses, his expression becomes slightly more upbeat) But, at the same time, Timmy's treatment is very expensive and it would deprive many, many many boys and girls of the treatment that they need for their own serious illnesses. I guess the insurance company knows best. Yes, I think they must. (Another pause. Then, Dr. Rogers smiles.)
Dr. Rogers: Anyway, like Sally said, we better keep moving. Dr. X, boys and girls, I want to show you all something very new. We just started doing it last month. It's been such a time and money saver! We call it the Upper Respiratory Infection Symposium. I see all the kids with URIs and their parents at the same time, say a few words, show them a video on
Dr. X: (checking his watch) I'm sure you're right, Dr. Rogers, but I'm afraid I have to be going. It has already been such an exciting morning! I think you're doing a bang-up job and I'm sure you've taught all the boys and girls a lot about modern medicine.
Dr. Rogers: Thank you, Dr. X. Good-bye. It's always a pleasure to have you in my neighborhood. Say good-bye, boys and girls.
Read Dr. X's original letter to Oregon Doctors
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