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I Bet You'll Care Then

I Bet You'll Care Then

There are many choices of topics I could comment on after last week's healings of the infirm. My practice is comprised of a large slice of real American culture. I am fortunate to have a diverse and informed patient population who are always willing to share their life stories and worldviews with me. I have learned much from those who have crossed the threshold of my office, and I am so thankful that almost everyone returns when their ailments flare or when their life just goes to pieces.

One thing that I have learned from those who share their views is that our country has much more in common than we are lead to believe by the media. It is no secret that I am a man with views that are definitely left of center. I have not crossed over into the areas that one might label me a socialist, however I support Medicare, Medicaid, Social Security, Veterans rights, Student Loan programs, education through the twelfth grade, and government regulation for industries that could take advantage of all of us: local electric companies, natural gas suppliers, city and county water companies, internet providers and sewage treatment plants to name a few.

Without question these are socialist programs of one kind or another, some managed on a federal level, some on a state level and some on a county level. When I discuss any of my socialist ideas with my patients, almost one hundred percent of them agree with me that these are necessary programs for our populace and should continue; we might disagree on the best way to serve the public by changing the management of the programs, but almost all of my patients agree that these are necessary.

When I mention healthcare and its continued industrial metamorphosis, they express frustration and anger. Not one of them believe that medical care is a privilege which was a great part of the debate concerning healthcare reform 15 years ago or more. They have all come to realize that when most people contract an illness, they should be cared for by compassionate, thoughtful, professional people who have chosen to work in the health care field because of their compassion for healing the sick.

I suppose we believe that all people choose their vocational journey in life based on some innate drive or passion that determined their choice of jobs. I preach to my children about finding work that they are absolutely passionate about; however it always seems as if life gets in the way and their choices do not reflect their passions. If we have failed as a country, we have failed in helping young people to find opportunities that incorporate their authentic passions in their work activity.

The healthcare industry as a whole is broken and infested with a healthy amount of greed. There is nothing wrong with compensating someone for a job well done, especially when it comes to our health. But the escalations in cost have far outstripped the value of the product. When I was in medical school, the overwhelming majority of students I knew who were in it for the money; pure and simple. Yes, fellow students talked about which field of medicine they thought they might enjoy; whether they wanted to personally treat patients or not; radiology and pathology appealed to students who did not want direct patient responsibility. Prospective surgeons wanted to perform invasive procedures as a way to cure disease, but seldom wanted to manage illness after the surgery was performed. But make no mistake, there was always an overlying concern of the greatest economic reward that was related to their choice of specialty or area of practice. Students were given published data on the specialties that produced the highest income. They were also told where they could go to do an internship and/or residency that would enhance their chances of being accepted into post graduate specialty and subspecialty training that would make them the most money. Another important factor in making one's decision to go to medical school in the first place seemed to be the common understanding that the practice of medicine was recession proof.

Currently, many of the physicians I know have sold their private practices to local hospitals and become corporately controlled medical practitioners. They have become nothing more than a mule to make money for the organization they sold out to. Alongside them are nurse practitioners, physician assistants and a multitude of para-ancillary staff to aid in the processing of patients. Their Mantra each day: get them in and out the door ASAP. More patients on the schedule directly translates to more money generated. Spend less than five minutes with the patient and move on. Many physicians spend more time with the drug company representatives than with their patients. After all, drug reps provide lunch and office supplies that benefit the healthcare machine but not the patients. Some clinics in Memphis have separate entrances for drug reps. And don't kid yourself, drug reps are nothing more than boots-on-the-ground lobbyists for the drug companies. Drug reps aspire to make the greatest amount of money by influencing the market share of their drug in their local region. Sound like Washington DC? It is. It is just a scaled-down local version of the political corruptness we experience behind the healthcare veil every day.

What's the answer to this runaway train? How do we salvage anything that is meaningful and healthy? What steps need to be taken to begin the process of change? How do we restore confidence in the public that physicians care about who they treat? How do we make sure that the advances in medical care are truly being made for the best interest of the patient and not for some venture capital group that wants a twenty percent return on their investment? How do we actually know that the general surgeon that wants to remove your gall bladder is actually suggesting it because the procedure is medically indicated instead of needing the money to support his vineyard in France?

I have many answers to these questions. But the most important realization about how to change the system is to look at the incentives that professionals and lay people alike have related to change. If one incentivizes a physician or medical system to change, they will. We have to think like an economist, not a businessman fueled by avarice. We as a society have to agree upon the definition of what good health means. Depending on the practitioner, good health is not a common nor clearly understood concept. Until all of us agree on what good health is, we cannot remotely find the proper incentives to make the system function at its Pareto Improvement. At the very least, we need to turn the system upside down, making proper and accurate compassionate care of patients the primal fundamental equation in the healthcare system, which will ultimately perpetuate iterations of the same regardless of its scope and span.

It can be done. I'm sure that those people who have a tight grip on the system will not let it go easily. Don't care about changing the healthcare system? Ignorance will not protect you nor will embracing the idea that we have the best healthcare system in the world when we do not. Just wait until you won't be able to afford an appendectomy to save your child's life as the hospital's chief executive officer is vacationing in his/her summer home in Portugal. I bet you'll care then.

Those days are already here.


Posted by Amanda Sanders at 11:19 AM
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