Sick of Doctors?
Then do something about it?
A Prescription for Patient Empowerment
An excerpt from pg. 194
… at the beginning of the twentieth century, doctors across the United States enjoyed a prominent status within their communities and earned a respectable income. Most had long-term relationships with the families they treated; they traveled to patients’ homes for most services and often charged fees in keeping with the family’s ability to pay, at times even accepting bartered goods in exchange for their services. Those were the days before the AMA emerged and the government set rules and regulations for medical practitioners. By the time World War II ended, medicine had become more “industrialized,” moving away from home-based care and offering physicians more prestige, power, and wealth than ever before. Salaries skyrocketed, third-party payer insurance buffered most patients and doctors from the charges for medical services, and powerful corporate interests stepped in to help drive profits even higher. The number and types of doctors we saw grew larger while our appointment times grew shorter.
A great number of Americans began to resent the almost factory- like approach to health care that over time became the norm. The good old family doc went the way of the dinosaur, and we were left to deal with the dreaded Doctor God. The cycle was still in motion. Insurance oversight eclipsed doctors’ authority and medical institutions scrambled to compete for shrinking payment dollars. Health maintenance organizations, with their managed-care approach, limited health-care access for many Americans and completely transformed the medical workplace and the doctor–patient relationship. Insurance costs skyrocketed and more and more Americans found themselves without coverage; some couldn’t afford the premiums and others chose not to pay them. Everyone — doctors and patients alike — struggled to find ways to deal with a system that seemed to offer no one the benefits of a sound, affordable, and effective approach to health care.
Where we stand today is in many ways an unattractive spot. Most modern medical facilities are run like any other corporation, with the primary focus on the bottom line. Services that fail to produce sufficient revenue are cut and resources are devoted to areas where profits are more reasonably assured. Some doctors feel betrayed: salaries for most aren’t as generous as they used to be, paperwork and administrative duties consume ever more time, and insurance companies — not doctors — call the shots when it comes to determining who is eligible to receive specific treatments.
Furthermore, many experienced doctors are retiring early to avoid the realities of life as an employee of a bureaucratic system. Frustration with poor working conditions, low pay, and flagging morale is taking a toll on other medical staff, too. Nurses also are retiring early and fewer people are entering the field. Couple these trends with America’s aging population and we may be looking at a perfect storm of medical difficulties.
We need to rethink our whole approach to health care in this country, but to a great extent, that kind of change begins one citizen at a time. Fundamentally, we — each of us — will begin the process of reinventing it by changing the way we work with our doctors. Ideally, we will come up with a system that incorporates the best of what has been good about American health care in the past with the rapidly changing benefits of emerging trends and technologies. To do it right, though, we’ll need to avoid the attitudes and practices and prejudices that have made our system so dysfunctional and realize that sound solutions rest on a foundation of personal responsibility — for staying healthy, red-flagging developing medical conditions, and seeking prompt treatment for those diseases and illnesses that we cannot ward off.
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