I am responding to your editorial “The Future of Health Care” (BDN Sept. 13). I have enjoyed reading the BDN for many reasons. Your handling of the health care issue is one of them. You have provided us with numerous viewpoints over the past four months. However, one viewpoint that was not provided in your recent editorial or in the op-ed pages over the past four months is presented here.

I am a retired general, vascular and hand surgeon who practiced in Plymouth, Mass., from 1972 to 2004. I averaged 78 hours per week either in my office or in the hospital. I state this only to help you understand that I have had a lot of experience working in our health care system. Since 2004 I have read many authors from the Institute of Medicine – a group of medical and business “experts,” government and academic economists, newspaper journalists, public health “experts,” insurance executives, think tank “experts,” and occasional physicians. By and large the issue of health care affordability is ignored (example, “Crossing the Quality Chasm” by the IOM) or dealt with by frustration and arguing over who is going to pay for it.

What is sorely missing is this: No one appears to be asking the medical profession as a whole (i.e. the AMA or the ACS) to create a more affordable and accessible health care system. Your editorial points this out beautifully. You simply don’t ask the question. The medical profession as a whole could create a much more affordable and accessible health care system if it were in their interest to do so.

One simple example of our system’s dysfunction is this: My son is a second-year resident in emergency medicine. He recently treated a woman in the emergency room who had a severe paronychia – a purulent infection around her right great toenail. He performed a digital block (numbed her toe), drained and cultured the pus, and then asked his mentor if he could remove the nail plate, which in fact was the right thing to do. His mentor asked, “Do you think you are a foot surgeon?” and told him not to remove the nail.

Consequently this woman was sent home with inadequate treatment and told to see a podiatrist, which she probably could not afford, especially after paying the emergency room bill. Removing a nail plate would have been a simple thing to do, especially with her toe already numbed up. This example of expensive but poor treatment is unfortunately common.

Our medical profession is not training physicians to answer the needs of our communities; rather, it is training physicians to answer the needs of their specialties, which fragments our care terribly and increases the costs. And our medicolegal system certainly does not encourage us to correct this problem. Who do you think can correct this problem – economists, public health experts, insurance executives? It obviously has to be corrected by the medical profession as a whole.

I recommend that an American president or someone of that political stature formally charge the medical umbrella organizations such as the AMA and the ACS to create an affordable and accessible health care system. Once that has been done, then the various experts noted above can discuss how to pay for it.

William Babson Jr. of Sinclair is a retired general, vascular and hand surgeon.