Retired Santa Barbara physician suggests reforms in ‘The Rape of Hippocrates’
Dr. Roger C. Dunham flew his Cessna from Santa Barbara to Lancaster to pick up a patient who needed immediate help but felt uncertain about being treated by physicians he didn’t know in an emergency room.
This wasn’t just any patient.
This was Dr. Dunham’s father.
During a phone conversation, Dr. Dunham had urged his father to call 9-1-1 and offered to call 9-1-1 on his behalf. His father preferred to hear back from his physician’s office, where he left a voice message. But it was a weekend, and no one was calling him back.
Unable to convince his father to call 9-1-1, Dr. Dunham decided to pick up his dad himself.
“I brought him to Santa Barbara in the space of 30 minutes,” Dr. Dunham said.
Dr. Dunham’s father was transported from the Santa Barbara Airport to Santa Barbara Cottage Hospital, where a cardiologist treated him for rapidly advancing congestive heart failure.
His father survived and lived for many years after that.
But Dr. Dunham, a retired Santa Barbara physician, said the problems with the medical system — one that failed his father and other patients because of a lack of primary care doctors but no lack of confusion — persist to this day.
He writes about that in the recently released book “The Rape of Hippocrates: A Pathway for the Rebirth of Medicine.”
The book sells for $24.95 (hardback) and $16.95 (paperback) at Amazon.com and is available at Chaucer’s Books on upper State Street in Santa Barbara.
In the book, Dr. Dunham calls for the establishment of more medical schools to expand the number of primary care physicians and for the simplification of billing, a complicated system that cuts into the time doctors spend with patients. He said doctors today have to deal with a whopping 69,000 billing codes.
He suggests other reforms as well to cure problems that he said were not solved by the Affordable Care Act.
Dr. Dunham practiced what he preached long before the book’s publication when he decided to offer his patients a flat, annual fee for all his services. Even house calls.
“They could call, and I was immediately available 24 hours a day. So many illnesses happen during off hours,” Dr. Dunham, 78, told the News-Press this week. “There was no billing. I discontinued all the billing mechanisms.”
“It changed everything,” Dr. Dunham said. “Patients overwhelmingly loved it.
“I continued doing it for 18 years,” said Dr. Dunham, who retired in 2015.
During the News-Press interview and in his book, Dr. Dunham stressed the need for more primary care physicians. He said the heavy patient load per doctor hurts the quality of care and pointed to his father, whose primary care doctor felt the stress of serving thousands of patients.
Dr. Dunham told the News-Press that one solution is to establish more medical schools. He suggested one could be added at UC Berkeley. (Currently California has 16 medical schools, according to internet sources.)
In his book, Dr. Dunham noted that while the population of the U.S. has grown from 309 million people to 330 million in the past 10 years — an increase of 21 million people — the number of primary care physicians has risen only by approximately 11,000 during the same time, from 209,000 to 220,000.
Dr. Dunham said that represents a workload of nearly 2,000 new available patients per each newly trained physician.
But only 36% of medical students will choose primary care over a higher-paying specialty to make up for the 10 years or so of training (including their residency) and near-zero income during that time, Dr. Dunham said.
He also noted primary care physicians, many of them fed up with today’s healthcare system, are retiring at a faster pace.
Dr. Dunham also writes in his book about the need for the medical profession to embody the Hippocratic Oath, which states physicians will do no harm or injustice to their patients and calls on them to practice their profession for the benefit of their patients.
He writes that although most physicians believe in those principles, the application of the oath has declined in the last 50 years. He said that’s a reflection of changes in the standards of the delivery of health care.
Dr. Dunham also cited surveys showing that only 56% of physicians are required to cite some form of the Hippocratic Oath when they graduate from medical school. He raises the question of whether patients can fully count on the other half of the doctors who didn’t take the oath.
And while noting technology has helped physicians, he said that too often doctors stare at their computers during their time with patients.
“It’s a godsend to get information, but can’t the doctor look at the computer between the discussions with the patients?” Dr. Dunham said.
He said doctors’ conversations with patients, along with the rapport that comes from a relationship developed between a patient and the primary care physician and the doctor’s knowledge of the patient’s medical history, can make a big difference. “Ninety percent of the time, a diagnosis can be made with a conversation about the specifics of the symptoms.”
Before he became a doctor and later an author of nonfiction and fiction — “The Rape of Hippocrates” is his fifth book — Dr. Dunham saw some adventure in his life. The Pasadena native served during the 1960s in the Navy as a reactor operator on a nuclear submarine that was engaged in espionage activity in the Pacific Ocean.
After his honorable discharge, Dr. Dunham attended the UCLA School of Medicine, where he graduated in 1975.
He went on to care for prisoners in the Jail Ward at the Los Angeles County Jail. After his work as a resident and chief resident at hospitals in the county, he started his practice in Santa Barbara in 1978.
He and his wife of 54 years, Keiko, have a daughter and a son and six grandchildren.
Dr. Dunham’s books have included “Spy Sub” (Naval Institute Press), “Final Diagnosis” (Penguin Press), “Surviving Mortality” and “Rogue Captain.”