THE ROAD TO HELLCARE IS PAVED WITH BAD INTENTIONS
This is the future folks…Hellcare. Read this on Reddit..breaks my heart. What follows is my perspective on what I believe is happening in countries like the United States and Britain…and why. I’m going hard and may seem paranoid..I don’t give a f**k.
“Healthcare” is big business–-the authentic practice of medicine is not. Venture capitalists discovered this decades ago. It’s why the U.S. health system is pretty much owned by private equity. The money is in prolonging illness, not improving health. Insurance executives desire healthy people because they pay into the pot, little goes out. Sick people with insurance get denied automatically; however, they can appeal. Predictably, the appeal process is designed to delay care, not resolve the issue. Health executives are fully aware that it’s more difficult for sick patients to fight–they don’t care. Hopefully, if the insurance company is lucky, in-between fighting and appealing, the patient will just pay out of pocket from sheer frustration…or die. Dead people cost nothing. Insurance pockets the proceeds and seamlessly moves on to deny more victims. Nothing personal, just business. In medicine, volume is where the money is. Patients are the commodities. Lots of patients, lots of money. Lots of procedures, lots of money. Lots of research, lots of money. Lots of good preventative health care…less money, so little incentive.
The healthcare business/corporate practice of medicine however, must appear as if their goal is in improving care and increasing access while helping hospitals succeed, because if they stated their actual intent a publicity nightmare would ensue. Spin marketing, that is advertising which uses meaningless words or euphemisms to imply intent that is false, is one of their greatest strengths. Buzzwords such as “increasing access”, “filling the shortage”, “value-based care” abound. Let’s focus on value-based care for a minute. It has 3 tenets: quality of care, provider performance and the patient experience. Any doc working in the U.S. hellcare system is well-acquainted with the “provider performance(metrics)” and “patient experience(Press-Ganey)” bulls**t. The better a physician is at metrics, the more money that can be made. Patient experience only matters in business because it means patients return and bring their money with them. So when I get badgered by clip-board cops because a patient complained they waited too long in the ED which was packed with patients, that is my fault. Although I may be the sole physician(single-coverage) at night covering an entire hospital, I’m expected to be Florence Griffith-Joyner. With lousy Press-Ganey scores, I’m no longer entitled to a bonus. So who keeps that money? You guessed it, the corporate bigwigs. Press-Ganey scores don’t actually represent the quality of care that matters(ie: health), it is more about customer satisfaction, as if I work at Target. Genuine quality of care, that is, how well I manage a patient, enhance their quality of life or provide a positive health care experience, is not rewarded nor acknowledged because it is irrelevant to the business.
Now here is where I am going to go hard. Before Henrietta Lacks(HeLa cells), the Tuskegee Experiment, the Mississippi Appendectomies, the LSD trials in U.S. Army soldiers, etc., there was the Nuremberg Codes(NC). If you don’t know where these came from, look it up.
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The Nuremberg Code had 10 points. I have attached #1. It is imperative that one understand that patient consent extends beyond human experimentation or research. It’s why consent must also be obtained prior to a procedure, when receiving a blood transfusion or undergoing medical interventions such as thrombolytics for stroke or pulmonary emboli.
My contention is that both the corporate practice of medicine and the scope creep movement deny patients choice by engaging in deceit, fraud, coercion, misrepresentation, duress, etc. Conflation of non-physician practitioners(NPPs) with physicians, for the sole purpose of misleading patients while simultaneously removing their option of being seen by a physician, is one example. Their modus operandi, fully sanctioned by legislators and politicians who refuse to enforce corporate practice of medicine laws or respect state Medical and Nursing Acts. In my opinion, by permitting the unsupervised practice of medicine by NPPs, legislators are enabling human experimentation, only in a more sophisticated model. Yeah, I said it. When laws designed to protect the public are removed by legislators who sanction the deceit and thus the experimentation, is that not a crime? If it isn’t, it should be.
In the United Kingdom, physician associates(PAs), who have no PA-accredited bodies or schools, who are neither regulated, licensed nor do they have a distinctly defined scope of practice(SOP), are nevertheless allowed to treat and manage patients as if they are physicians. To top it off, the physicians’ regulatory body, the General Medical Council(GMC), is currently under consideration to be tasked with implementing regulations for UK PAs. Many UK physicians take issue with this potential new function of the GMC. Despite physicians’ concerns, the GMC has threatened that if docs don’t stop “bad-mouthing” this unregulated profession, there will be repercussions. The GMC, whose guidelines clearly expect physicians to report substandard care as they are expected to protect the public against bad medical practices, are effectively muzzling and preventing doctors from voicing their concerns about PAs, EVEN WHEN CARE IS COMPROMISED. It is the same in the U.S. Corporate flunkies, which includes traitor trash docs, gaslight and/or punish physicians who do the right thing–protect and inform the patients/public so they can better advocate for themselves.
The public was never supposed to know that these ingrates, who claim that they want to improve access to care and be more efficient, are doing neither. Lip service. Preventative care keeps people healthier and ameliorates long-term health outcomes. This is indisputable. However, it hurts profits. Solution: Get rid of the doctors who effectively and efficiently provide good preventative care, Internal Medicine/Family Medicine/Pediatrics/GPs/Psychiatry, etc., aka primary care physicians, and replace them with people who don’t know s**t about medicine. Then convince the public that these charlatans are equivalent to Primary Care doctors. Lump everyone under “provider” and state they practice “Primary Care” rather than medicine. Because NPPs cannot practice authentic medicine without the appropriate education and training. Claiming they practice primary care is an effective marketing euphemism that makes the s**t sound simple, despite it being the most difficult field to practice in because it encompasses the entire human body and its systems. More money is made when more doctors become specialists and when more procedures can be performed. Again, profitability of a health system is heavily dependent upon keeping people ill. An unlimited supply of damaged human commodities is virtually assured when non-physicians are empowered to practice medicine without the requisite training and restrictions that are placed on physicians. Positive health outcomes for industrialized nations such as the U.S. and UK are no longer enough of an incentive. The U.S. has the worst health outcomes of all industrialized nations, and we continue to drop. We aren’t doing s**t about it because not doing s**t has made health insurance executives, corporate C-suite suits, administrators, shareholders and the like obscenely wealthy. THAT, LADIES AND GENTLEMEN, IS THE INCENTIVE. Now the UK is privatizing its health care system, using the U.S. corporate model because its leaders desire a piece of that financially glorious salacious pie. What about the patients you ask? Well, what about the patients? Unless you have good insurance, you make a nice lab rat on which non-physicians can practice because without oversight, regulation or enforcement of existing laws and removal of regulations designed to protect the public, that is exactly what you will be. A lab rat. A guinea pig. An experiment that no one will assess or follow up. Consent will not be requested or given as the powers that be(government, legislators, hospitals/health care facilities, licensing/compliance boards, etc.) have eradicated patients’ options. Once primary care physicians are deleted from the equation, there is only one alternative. Non-physician practitioners.
I adamantly believe that the ultimate, mephistophelian, evil objective of corporate medicine leeches and the sycophantic scope creep enthusiasts is to make primary care physicians obsolete. These docs interfere with the profit-margin by doing their jobs too damn well. Now tell me I’m wrong. Then prove it. I’ll wait.
“The standard you walk past is the standard you accept”.–Lieutenant-General David Morrison, former Chief of the Australian Army
Brilliant! A cri-de-coeur of the highest order. Unfortunately, until the stench of the corruption in medicine reaches astronomical heights, nothing will be done. And since the media, with the exception of your (and like- minded) blogs, chooses, or is ordered to, ignore the problem, I’m afraid it may be a very long time.
Amen, amen.
A thorough, unique take. I look forward to the LELTs posting to explain how you got it wrong.
My God, when Natalie writes and HITS the targets, I am in heaven. While we all have the same emotions, only Natalie can effectively go for the jugular. I live for her columns.
“the ultimate, mephistophelian, evil objective of corporate medicine leeches and the sycophantic scope creep enthusiasts is to make primary care physicians obsolete”
Very true.
And the morons at the AAFP are aggressively pushing what they call “team-based care,” which is bureaucratese for “no physician in the house.”
BINGO. To your last statement.
That’s a long post on a weekday morning.