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The Paradox for Docs

Op-Med is a collection of original articles contributed by Doximity members.

How did it happen that the practice of medicine has become just another corporate industry? That what should be an essential human service has been reduced to a revenue-generating commodity? Though it is rampant in Western culture, the trend toward greed has evidently become the highest priority — but how did it come to supersede even the sanctity of human life?

Most of us did not understand decades ago that we were selling our proverbial souls. We were promised better reimbursements and fewer management headaches if we signed on with HMOs and later, with entrepreneurs who would handle the management of our practices. Most of us did not understand because our focus was on alleviating human suffering, remedying human ailment, and repairing faltering bodies. We did not see the danger looming on the horizon.

Medicine as we old-timers knew it no longer exists. The priority of our new health care industry is no longer health; it is profit. And the business model brought to bear on our unsuspecting patients has a new purpose: how to make the most money. In this process, patients have been transformed into consumers, preyed upon by pharmaceutical companies and targeted by large organizations, which compete for them to patronize a specific business or buy a certain drug.

Now, we not only need to be concerned with accurately diagnosing and managing specific maladies, but we must also placate our customers when our treatment does not jibe with the latest TV commercial. Then, we invite the customer to review us in the same way we would ask someone to rate their experience buying an Apple TV. Make no mistake, these reviews are not designed to determine if the patient was treated appropriately or even if they improved. They are not designed to discover if the front desk staff or triage nurse was compassionate and friendly. Do not be fooled. They exist solely to determine how likely the “consumer” is to return to an establishment. How likely it is that they will generate another “sale.”

A large population of our patients has become increasingly demanding and difficult to treat. But the patients cannot be entirely blamed for complaining about the coffee creamer selection in the waiting room, or the fact that they had to wait to get their flu shot until after the cardiac emergency was addressed. When patients are treated as “customers,” it is no surprise that they begin to act the part. Convenience is a cardinal value in the American commerce experience. And in business, the customer is always right — even when their opinion conflicts with solid medical practice. What if the customer wants antibiotics for a viral infection? An MRI two hours after a shoulder injury? Three appointments in one week for the same flu symptoms that are not expected to resolve for up to 10 days?

So, the Press Ganey scores pile up, the profiteers evaluate our performance via our customer satisfaction surveys and “productivity” measures, and the quality time we can spend with individuals dwindles day-by-day. We juggle charting, thoughtful evaluation, and people-pleasing. We struggle to find time for the human connection. Some of us feel like hamsters on a wheel. Many take our work home with us. After 11 to 14 years of higher education and way over half a million dollars in debt, many of us are depressed, burned out, or contemplating suicide

How will we fix this? 

One thing I do know is that it will not be simple. It is not a matter of choosing to be a Democrat or a Republican, a liberal or a conservative, to be for or against “Medicare for all.” I believe in my heart that every human being in this country deserves access to high-quality health care; I also know that comes with a hefty price tag. Who will pay for it?

There will have to be reform on both sides. Big Pharma will need to scale back its internal salaries and dispense previously cost-prohibitive medications at a reasonable price. Venture capitalists who have chosen medicine as their vehicle to make it to the Fortune 500 will have to settle for making a lot less — or choose a different venue for their affluence. And on the other side, patients will need to be re-educated regarding their medical expectations. Not every fall requires an MRI. Not every afebrile runny nose requires a visit to the doctor, and it certainly does not always warrant antibiotics. Sometimes the patient needs to be patient, and ride things out. We need to allocate our resources better so that those with serious health issues can get the procedures, medications, and care that they need.

And finally, on a societal level, “Medicare for all” will likely resemble “Medicaid for all” — and it will still cost the public a fortune in taxes. Our population may not take to that happily. We will also need to scale back the barrage of media influence, which operates with the goal of convincing people that they “must have” this drug or be cared for by that institution. We are one of only two countries on this planet that allows direct-to-consumer advertising in medicine, and we have one of the most demanding populations when it comes to health care. Hard to know which came first, but I have a hunch. I do know we cannot continue to treat medicine as an industry for profit.

Illustration Collage by Jennifer Bogartz / Getty Images

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