About the Benjamins
Edwin Leap, MD, a long-time reader of this blog, did a great job in his piece in Huffington Post recently. It is called Medicine is Not About Money, Except When It Is. He exposes the hypocrisy that goes on in medicine today as it relates to doctors supposedly being bought out by third parties and how we were taught than money, in general, is bad.
But the prevailing attitude in medicine towards the reps, and pharmaceutical companies, was all a shade of the way we were taught to view money in medicine. Even in medical school interviews, we weren’t supposed to say much about money. ‘I just want to help the sick and helpless. What do you mean, money? You get paid to be a doctor? How about that!’ We were supposed to pretend that money wasn’t part of the process, even though we knew it was. And presumably, our tenured professors had an inkling as well.
I especially like how he points out the massive amount of money being spent by these third parties at conferences. Where does that go?
Maybe, just maybe, money isn’t all bad.
We need to readjust the way we educate physicians. Young doctors need to understand money more clearly from the start (especially the $200,000 in school loans part). But they must also grasp the hypocrisy that tells them that medical businesses, like Pharma, are inherently evil (because money, you see), even as hospitals, doctors, governments (yep) and all the rest continue to try to accrue more of it.
Great job, Ed!
Outcomes without decisions. That is the goal of every bureaucracy, and the goal towards which American Medicine is rocketing towards. If neither the Doctor nor the Patient is to be trusted with making an objective decision, at least in the American Myth: patients are seen as grabbing and grubbing for every little medical perk, no matter its usefulness, and doctors are alleged to make all their decisions simply on their profitability. The propaganda, in this case, is solid and all-encompassing.
Someone Else should make these decisions -and bureaucracies are useful machines for turning questions into outcomes without any rational decision actually being made. With the worship of Best Practices, we turn to a superstitious myth that the Algorithm will decide what is Best.
Since we allow universal criticism of every decision, no matter how well-substantiated the decision might be, or how uninformed the grievant might be (hi, Jenny McCarthy!), it makes no rational sense to stick your neck out and have an individual opinion that risks being followed. You could get in trouble with the Mob Conscience, and be on Oprah.
We race towards the passive choice of letting things unfold without intervention – precisely the medical care practiced in the Paleolithic Era. The superstition of the capricious Gods has been replaced by the superstition of the Rules. How far we have come in thousands and thousands of years!