Medicine for Profit
Medicine should be an essential human service in a country as wealthy as the United States of America. Instead, it has become a profit-driven industry, its status just another vehicle for entrepreneurs to scale to Fortune 500 ranks. As if saving lives was on par with marketing a new microchip or a “must-have” fashion wardrobe. There are some functions of society that should not be treated with the standard business model. Medicine should be the sentinel that guards the sanctity of human life, not the revenue-generating commodity it has become.
Last year, a 64 year old patient came to my urgent care office for removal of stitches in her chin. She had been knocked over by a bicycle on her vacation in Paris the week before. She told me she was taken to a Parisian hospital and had x-rays of her neck and shoulder, a CT scan of her head, and sutures placed in her chin. I asked her if her health insurance had covered her overseas and she said the Parisians had treated her for free. It cost her more out-of-pocket to be seen in our urgent care center, in her native country, just for suture removal, than it did as a stranger in France to have a full evaluation of her head, neck, and shoulder, and repair of a facial laceration.
As more and more American medical practices are consumed by corporate amalgamates, and multibillion-dollar insurance companies determine what procedures are permitted, our humanity is being pushed ever further to the sidelines. If a French woman had the same bicycle mishap on Broadway in New York City, she would be lucky if her bill was less than $5000, as would our own uninsured citizens. Half the commercials on our airways are about how wonderful and caring various healthcare systems are, and the ever-present pharmaceutical ads portent sympathy to various diseases, but it all comes priced for profit.
What looks like concern and is passing for compassion is not that at all. When patients receive a customer satisfaction survey after their visit to their gastroenterologist, it appears to be kindhearted. But the survey’s purpose is not to determine if patients were treated with a high level of medical acumen, or if the front staff was friendly and courteous, and it is not focusing on the outcome of their medical problem. These things matter only as a measure of one thing: how likely is it that these patients will patronize that particular office and corporate system in the future.
Meanwhile, we doctors are being evaluated on our “productivity”, meaning how many patients we can see in an hour, or a day, and how much revenue we can bring in for the corporate owner of the practice. We are also evaluated on the scores from those customer satisfaction surveys. Sometimes this includes a patient’s displeasure at the coffee creamer selection in the waiting room. What we are not evaluated on is how many lives we save or how well we are adhering to evidence-based medicine. Or how much we care about our patients.
Because the surveys are so important now to physician salaries, bonuses, and promotions, we docs really feel the pressure when our patients desperately want an inappropriate antibiotic for a simple cold, or insist they want to try a new medication or procedure they heard about on television, even if, in their case, it could cause more harm than good. Often when we choose to practice good medicine, recalling our oath to “above all, do no harm”, we then wait for the proverbial hammer to fall, as we are called to task for not keeping someone “happy”. And it has become even more challenging to find the time to explain our reasoning to our patients because that extra time compromises our productivity.
When patients become customers, or consumers of healthcare, the priority of service changes from healing them to pleasing them. Physicians try hard to hold fast, but the financiers that own us are literally writing the script. One hopes, of course, that there will be a high degree of overlap between happiness and health, but in the short-term, the time when the patient is filling out their questionnaire, it is not always evident yet.
In the past, I was required to take risk management courses to minimize human error; now I am required to take compliance seminars, to maximize billing. Much of the extra time we are obligated to spend on the EMR, or electronic medical record, is simply to justify the highest possible charges or to satisfy insurance companies.
As a physician, I hope that my patients can see that the apparent benevolence this new industry shows them is only the same consideration any company shows to its potential consumers. Nothing more, and nothing less. As consumers, my patients can expect to be preyed upon by the media which is trying to entice them—the customers—to choose that which will fill the pockets of the corporate giants more quickly: the insurance companies, Big Pharma, and the multitude of new impersonal commercialized healthcare systems. Advertising is not at all necessarily related to what is best for the health and well-being of patients.
I am old enough to remember when doctors routinely treated a percentage of patients as charity. Now, I cannot give a nebulizer to a disabled, wheezing, mother of three who cannot afford it without clearing it first with the board of directors of some multibillion-dollar corporation; a monumental task. Greed is consuming every corner of our existence in Western culture, but some aspects should stay sacrosanct.
What would it look like to have a society whose highest value was not the accumulation of wealth, but the practice of kindness?