We all remember the financial crisis of a few years ago, brought about by banks who were "too big to fail". Now we have hospital networks that are too big to care. Businesses are accountable to their shareholders first, so they focus on products and services which are the most profitable, not what's best for people's well-being. In fact hospitals have more to gain financially from more complications and worse outcomes for patients. Whom should doctors be accountable to?
The AMA code of ethics states
"Under no circumstances may physicians place their own financial interests above the welfare of their patients. The primary objective of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. For a physician to unnecessarily hospitalize a patient, prescribe a drug, or conduct diagnostic tests for the physician’s financial benefit is unethical. If a conflict develops between the physician’s financial interest and the physician’s responsibilities to the patient, the conflict must be resolved to the patient’s benefit."That rings completely hollow in today's profit-driven healthcare system of the US. (Can we even call it a healthcare system, since it's neither about health, nor about caring, but all about profit?) How are physicians supposed to put aside financial interests in favor of patients' benefit, when they have to answer to their boss (hospital admins), and meet production quotas, as if they are just factory workers in an assembly line?
We keep hearing how competition will improve healthcare delivery. Is the delivery of medical care supposed to be about competition? Are doctors supposed to "compete" against each other? Based on what factors? In medical school we are taught evidence-based medicine, the art of history-taking, and physical examination. We are not taught pricing. And for good reason! We're not training to stand by the side of the street and sell peanuts; we are training to care for fellow human beings! When did that distinction become lost in our society?
Medicine is not a commodity to be traded, be competed for, be analyzed by MBAs, or be measured for its efficacy through RVUs. It is a human relationship between patient and doctor. So what is so special about medicine? (pdf)
"Unlike a commodity, the primary meaning and importance of medicine has little to do with its efficacy, and more to do with a relationship between one human being in need and another who cares and is trained to help. Efficacy is sought in medical practice because the healer first cares. Efficacy does not imply a commitment to caring, but caring does imply a commitment to efficacy. Efficacy is the primary language of commodity transactions. Caring is the primary language of medicine."I'm not training to be a physician so I can make shareholders rich. Let's not sully our noble profession by adopting the language of Wall Street, lest we have a shameful throwback to the 19th Century!
Physicians fight disease, and extend and improve the quality of life for their patients. It is quite fair for them to expect a reasonable financial and spiritual reward for the service that they provide to their communities. They want to be rewarded and appreciated for what they do. At the same time, the healthcare system needs to maintain the health and well being of members of society, while keeping costs within reasonable economic constraints. It is too soon to tell if the recent reforms brought about by the Affordable Care Act will satisfy the physicians' needs and those of the general public, especially the poor, but for sure it leaves a lot to wish for by all sides.
Many doctors have chosen to take an alternative path, and "live off the grid" from the whole insurance system. These doctors view medicine as it should be, "more as a ministry than an industry". By rejecting the obsession with growth and profit, they provide better service to their patients, while maintaining better work-life balance for themselves. They derive more satisfaction from their work, while better serving the health needs of their communities. The healthcare system as a whole benefits from lowered costs, since these physicians reduce the number of expensive tests and procedures that are performed or ordered.
Medicine is not the realm of bean counters. If we let them make the rules, we should be aware of the type of reality they create. If that reality does not bring us happiness, then we need to take back control over our profession. Ultimately we create the reality we live in, and if we are not happy with it, we have only ourselves to blame. The good news is that we already know what works (pdf), so there is no need to reinvent the wheel. We just need to have the will to get there.
10:15 PM PT: Community spotlight! Thanks so much!
Tue Feb 04, 2014 at 7:06 AM PT: Thank you for putting this in the recommended list. I'm thrilled!