Farmed Out Medicine   Do you remember the good old days and what happened when we needed to go to the doctor?   When I was a little girl—but, of course, that was a long time ago. Nonetheless, when I was a little girl and I got sick, my folks took me to our doctor who had cared for my mother before I was born, and who was the same doctor who had delivered me in the local hospital,   His name was Dr. Miller. His office was half of a house and he and his family lived ion the other side. He had a little boy who peeked through the window of the office and later asked his dad why he made the babies cry.   When we had to see Dr. Miller, we arrived at his office and sat in a small waiting room. There was no such thing as an appointment. It was first come, first served. Sometimes we got right in. other times we might wait for as long as an hour.   Dr. Miller would open the door to the inner office which consisted of two rooms, an exam room and his office and invite us in. It was always an anxious moment. After the exam and diagnosis, there was usually a much dreaded shot in my bottom. Then we moved to his office where he opened deep wooden drawers, found the envelope he needed, and dispensed the miracle of penicillin.   Reward quickly followed. Out next stop was the local stationers’ where shelves of Nancy Drew mysteries awaited my attention. They were little hardbacks for a dollar a piece. Between the shot, the medicine, and Nancy Drew, I usually felt better in a couple of days.   That was fifty plus years ago.   Now we live or die with a good bit of farmed out medicine. The official term is outsourcing.   We outsource most industries from car parts to shirts, from computer support to aqua culture. We send our orders to places and even countries with names we’ve never heard of nor can spell—places where we buy services and products for a tenth of what they would cost here at home. And if we’re considering linen blouses or mass-produced windshield wipers, the system does seem to keep our American expenses down. And if these products are faulty, we simply return them and get replacements or our money back.   But now it’s outsourced medicine. A big file of numbers, slides, and scans is faxed to Indian, Arizona, or Anywhere, Planet Earth. Someone there reads the chart that by now is four inches thick and in a few hours’ time says, “Yes, you may have the treatment/surgery/cure.” Or says, “No. I disagree with your doctors at home, your specialist, the medical team of the treatment center who have seen you many times. I disagree with the doctors who know you, have known you for decades. I disagree with the doctors who have seen you weep, seen you weak, seen you fight. And so you may not have the treatment/surgery/cure these doctors feel is best. The answer is ‘no’. Appeals may follow.”   It’s an odd system. The ultimate decision for the quality and perhaps the quantity of life is made by doctors who don’t know you, will never know you, who don’t do the treatments your doctor does. Information from the internet is applied to that four inch thick file.   And there you are. One unknown doctor has the power to throw a switch and stop the entire train.   It truly is an odd system. And this is a sizable portion of our health care/sick care system in the United States today.   None of this is news to millions of people. Millions of us grew up with a Dr. Miller, Nancy Drew, and being known. And now millions of us depend on complete strangers sometimes for our very lives.   Of course, fifty plus years ago there would have been no science available to heal as there is today. Nor the hope for an extended life beyond life-threatening diseases. But, as always, we gain at a price.   My old friend, Dr. Miller, has long since died. I’ve outgrown Nancy Drew. I’m only sad that we’ve also had to outgrow the intimacy, the immediacy of that care.