People in the Medical System are Secondary to the System Itself

In 2020, 18% of the GDP will be spent on healthcare. Healthcare is now a business term. The essential doctor-patient relationship now has scores of ancillary industries built around it. Healthcare organizes the doctor-patient relationship into a system whereby the association between these two can be financially exploited as much as possible by hospitals, clinics, health insurers, the pharmaceutical industry, and medical device manufacturers. In fact, the more tension and resentment between doctors and patients, the better it is for the business of healthcare. The non-alignment of physicians and patients creates a need for a business or “system” of healthcare.

This dynamic is maintained by overworking and under supporting burned out doctors on one side and patients who leave feeling unheard, overwhelmed, frustrated. Next, the patients are presented with confusing and inflated bills through a process so opaque that neither patients nor doctors can understand it and no one will willingly explain it. Patients are sent large bills and blame the doctors. In this orchestrated scheme the U.S. spends more and more on healthcare and those who gain the least are the patients and the doctors.

As this widely circulated graph shows, the incremental increase in complexity and administrators necessary to manage and feed the system has been accompanied by a rise in healthcare costs. The real irony is that this “system” which has taken over healthcare is no one person’s idea or creation. It is the unintended, perhaps inevitable consequence of having to interface and provide large scale delivery, technology of all sorts, safety, reliability, quality, and a knock your socks off experience. 

As physicians, we have become a box on someone’s spreadsheet, and a smaller part of a box on that someone’s boss’s spreadsheet.

This is reality. Acknowledging the reality of the situation is the first step in coming to grips with the existential angst that is defining our era.

I do not mean to equate the business of healthcare with the practice of medicine. To those of us in practice, medicine, both the science and the art, brings us great joy and purpose. We have dedicated our lives to helping others and we are nothing if not resilient. 

As we move forward, I do not see a simple solution to this problem, nor do I believe there is a particular set of tactics we should pursue that will help us fix this. As physicians we are the true medical experts and we should not be afraid to speak up on behalf of our patients and ourselves whenever we encounter situations where the business of healthcare is placed above/or is in conflict with the practice of medicine.

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