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I love being a physician and the practice and art of medicine. To me, there is no other job or profession more rewarding or nobler than to have a patient entrust their very person to you for you to administer them care. That is not only a huge responsibility, but, more, a tremendous honor.
To safely guide a newborn's head into the world and everyone goes home happy and healthy; or being in the operating room, working with your surgical, anesthesia and nursing teams to safely remove a patient's tumor; or to get the patient to the recovery room knowing you've made a difference in their body (and hence, their life) by relieving the pain that had them bound? My God. There is nothing better than that. Nothing. I'm sure most, if not all, of my medical colleagues share my enthusiasm and passion for our profession and calling.
Yet despite the love of our profession, the past 20 years have found physicians utterly disheartened by the influx of "business" into what should be the pure, unadulterated practice of delivering quality health care to the patients who seek our skills and services.
You've heard the phrases: HillaryCare. RomneyCare. ObamaCare. I found it curious that many of these programs were advanced without proper input from...doctors and patients. As President Obama and Congress summon legislators and insurance executives to Washington to discuss health care reform and regulate costs, I have yet to hear anyone address, nor seek to restore, the centerpiece of health care delivery: The sacred doctor-patient relationship. This bond is paramount to health care, and should not be ignored or minimized in this national debate.
Nor should it be dictated to by insurance companies, which, like a thief in the night, swooped in, usurped the medical profession and have "managed"--i.e., mangled--health care delivery for the past two decades. I call the invasion the "raping of the medical profession."
How can this invasion be reversed in such a way to both restore the doctor-patient relationship and minimize costs? Simple: Dismantle the insurance companies' modus operandi.
By definition, insurance companies are "financial institutions that sell insurance." They are not clinicians. They cannot and should not be the determinants of health care delivery.
They should not decide which doctor a patient can see, nor what treatment options we may or may not discuss with our patients. They should not dictate patient management, nor determine need for surgical procedures or length of hospital stay. They should be national claim-processors only. [Millions of dollars saved right there.]
All insurance physician "networks," "panels" or "plans" should be completely abolished. These plans deny doctors our right to free enterprise: To see/treat any patient seeking our services, and whom we wish to serve. They also deny patients the right to the doctor of their true choice, restricting choice to one on their "plan." There should be an open market.
Insurance networks are also potentially dangerous. As a physician, I might wish to refer my patient to another specialist whose work I know and trust. But if the doctor I want for my patient is not on my patient's "plan," I put my patient (and myself) at potential risk, as the patient seeks services from a physician unknown. Unfettered physician access negates this risk.
In days of yore, physicians often cared for generations of family members. "Networks/Plans" severely disrupted that pattern of care because different family members may be on different plans. Or, as one changes jobs, insurance options likewise change, often disrupting the trusted doctor-patient alliance.
To improve efficiency in the system, and save millions in administrative costs, "pre-certification" for procedures and operations should be eliminated. What is "medically necessary" is a decision made between doctor and patient...period. First of all, do you know how much time this takes? Office staff can be put to better, more efficient use. No doctor seeks to perform unnecessary procedures on a patient; doing so increases risk to patient and physician alike. Give us some credit.
Medical insurance must be portable, and patients should not incur more out-of-pocket expenses if injured while traveling and are away from their hometown "PCP."
Hospital charges must be brought under control; regulated, even. The '$10.00 aspirin' and the ‘$91.00 liter of IV fluids' must go. And pharmaceutical companies can greatly reduce their costs to consumers by decreasing advertising budgets and restricting employee perks--such as first-class-only flights, super-fancy hotel stays and nightly lobster dinners, schmoozing international clients.
All physicians must work in the highest spirit of our calling, at all times, for all patients. We should not be driven by ego, greed, nor attempt to cheat the system.
That said, and despite some people's gripe, physicians are not the prime culprits of exorbitant health care costs.
We studied hard to succeed and we work long hours. Our brains have to be "on" at all times. When a patient calls at 3 AM, what we tell our patients could be a matter of life or death. We don't often get a ‘do-over.'
We are often urinated or defecated upon. Patients cough in our faces and we are exposed to their contagious diseases. This is not a complaint, just a fact...the reality of what we experience as we give care to our patients.
Do I feel physicians deserve a decent, even highly-paid, income? Yes. How much is it worth for someone to help save your life, to remove your cancer or to diagnose a life-threatening condition in your still-in-utero, unborn child?
In 2008, former heavyweight boxing champion, Evander Holyfield, rhetorically asked, "Can you imagine making $36 million dollars in 9 minutes?" No, Evander, I can't. But while athletes and entertainers make millions of dollars to amuse us with balls or music (and actors pretend to be someone they are not), those of us who actually serve our fellow man have to fight to get paid. This applies to doctors, teachers, police and firefighters. There is a terrible inequity in our country regarding what is valuable. We highly reward foolishness, and marginalize those who work hard to serve others.
Yes, doctors would like to get paid what we charge, but this hasn't been the case nor will it be going forward. But costs can be contained if the payment schedule is consistent, reliable and timely. I'm even open to national price-fixing, as long as it's fair and reasonably determined. No physician can provide quality care, and capable staff, as expenses rise, and reimbursements are unpredictable, variable, and precipitously fall.
Undoubtedly, health care reform is needed and costs must be contained. But any national discussion must primarily include input from health care professionals; not businessmen, insurers, politicians and lawyers. Health care delivery must be returned to the providers of health care--doctors--and those who receive it, our patients. When it comes to health care delivery, it's time the insurance companies step aside.
To all...Be Healthy, Be Blessed... and make sure you are Living Well, Despite Catchin' Hell, a book about health, sex and happiness, with a foreword by Pauletta Washington, musician and wife of Academy Award winner, Denzel Washington, and endorsed by psychologist Dr. Jeff Gardere and others.
Copyright © 2011 Dr. Melody T. McCloud. All rights reserved. Any excerpts reproduced from this article should include a hyperlink to this-my original post on Psychology Today, with author credit. Feel free to post the link to this, and any of my PT posts, to your social network pages.
For other posts about the practice of medicine, and/or health care delivery, click here, and here, and regarding Faith and Illness (including mental illness) click here.
