The recent rants of Gerard Genoli (http://theadvocate.com/news/opinion/10278705-123/letter-keep-politics-out-of">“Keep politics out of the doctor’s office”) make one thing perfectly clear — he is mad as hell, and he is not going to take it any longer!

Is he mad because we are the only Western democracy without universal health insurance coverage, including Europe, Canada and Japan? Or is it because health care here is so expensive (about 17 percent of GNP) compared to other countries and the quality of our care no better? Could it be because the new treatment for Hepatitis C costs $84,000? Or that his uninsured patients are charged much more than Medicare or private insurance patients for laboratory and hospital services (“Time” March 4, 2013). On the other hand, has he expressed any gratitude that he lives in the only country in the world where any doctor willing to work is practically guaranteed a six-figure income?

Not exactly. He is enraged that payment for some hospital services has been reduced, allegedly by changing reimbursement codes. He claims doctors will do less for their patients if paid less.

But his chief complaint is that “government” has had the temerity to interfere with his “doctor-patient relationship” — a statement he doesn’t define or explain. Sound familiar? It is, indeed, redolent of Republican rhetoric opposing Medicare in 1965 and the Affordable Care Act in 2009, although the intervening years have turned up no bureaucrats in doctors’ offices.

My take on the doctor- patient relationship after 40-plus years as a general practitioner, internist and subspecialist (rheumatology) is that it is extremely varied, occasionally approaching the hallowed version of song and story, but chiefly subject to the vagaries of both participants. If, in my practices, we developed a mutual tolerance/appreciation of each other, the relationship would continue, unless the patient lost his/her insurance and had to be referred to the Charity Hospital for follow up — a killer of the relationship. Medicare, in that sense, is the greatest facilitator of doctor-patient relationship and never “interfered” in my patients’ treatment.

The practice of medicine will continue to change to meet the challenges it faces, but the competent and caring physician should continue to give and receive patient and personal satisfaction. Quite likely, the freelance/entrepreneur type of physician, like Dr. Genoli, will find it distasteful to adjust to the changes that will occur to attempt to deal with the problems I enumerated above. These changes may attract a different type individual to medical practice, but I continue to believe it an unparalleled privilege.

Herb Dyer

retired physician

Baton Rouge