How did our calling become a job? (Part III of IV)

How many times a day do I hear other healthcare providers ask the title question? A dozen? A hundred? How many times have I asked myself the same question? We all mean it. We all wish someone would give us back our vocation.

People providing health care: nurses, doctors, respiratory technicians, pharmacists, etc. believe that we were called to do what we do. When we chose to go into healthcare, we were answering a call to nobility, not simply doing a job to pay the bills.

What has caused healthcare to go from noble vocation to painful job?

health care practice
Over the past century, dramatic advances in medical knowledge and technology have profoundly altered the role and capabilities of healthcare providers, as well as their relationships with patients.

My grandfather graduated from the University of Pennsylvania School of Medicine in 1912. In his day, there were two types of doctors: surgeons and physicians. That was it. Today, doctors are specialists and super-specialists. Orthopedic surgeons operate on only one joint. Care is now provided by teams, rather than by a single doctor.

Using modern capabilities such as CAT or PET scanners, both the structure and function of all internal organs, including the brain, can be assessed. No invasion of the body. No doctor lays hands on the patient at all.

Between superspecialization, team care and the interposition of technology, the doctor is increasingly separated from the patient.

Finally, there is the public perception of the broken promise of healthcare. Modern healthcare has been oversold. Without meaning to, doctors have left patients with the impression that medical care can fix anything. You and I know that there are many, many medical conditions for which there are no good treatments. Intellectually, patients know that this is so, but as soon as the disease appears, emotion takes over. The provider becomes God. God will save me.

When the patient does not fully recover, has an adverse outcome, or succumbs, it is obviously God’s fault. Doctor-God has become Satan. Patients expect healthcare providers to be what they can never be: perfect. When suppliers demonstrate their humanity, including limitations on what we can do, or when our imperfection manifests itself in error, the bubble bursts and the relationship of trust becomes contradictory. The trustee becomes the agent of my anguish.

Now comes the medical lawyer and the health bureaucrat.

Healthcare Administration and Litigation
As a child, I watched patients reach into their wallets to pay their doctor, my grandfather. They had a fiduciary relationship in both a financial and ethical sense. As a doctor for 35 years, I have never had a patient pay me out of pocket from him, ever.

The financial separation of the doctor from the patient, called the microeconomic disconnect, prevents the free market from working in health care. Consider the phrase third party payment. By definition, the third separates the two parts—the two halves—that make up a functioning free market: supply and demand.

When you go to McDonald’s, you choose the food, you pay for it, you eat it, and you evaluate it. McDonald’s is the provider and you are the asker, the consumer. There is no third. It is only the provider and the consumer, who balance each other through price competition (between providers) followed by exchanging money for products or services.

In healthcare, the patient-consumer does not pay the doctor-provider. They are financially ‘off the hook’ by a third party, the insurance company, which pays a predetermined amount to the doctor and/or hospital. Offer and demand I can’t equilibrium because: a) there is no direct financial connection between the consumer and the provider; (b) both the price and the refund are fixed: they cannot change; and c) the one who consumes is not the one who determines the value and worse still, the suppliers do not compete neither in price nor in quality.

Every rule or regulation drives another small wedge between the doctor and the patient. Instead of protecting the patient, each additional regulation further restricts what the provider can do to serve their patient. Rules and regulations are the government that stands between you and your patient.

Instead of patient or innate altruism vocation the service provider is now the government vocation the shots, expanding the power of its bureaucracy, and generating enormous expenses that the Public does not see but must pay.

A final intrusion into a provider’s previously satisfying life is the wrong system. While your financial expense is substantial, billions of dollars per year, the cost is far greater for the soul of healthcare.

The medical malpractice system is designed to deal with adverse medical care outcomes and errors. Based on the tort (civil tort) legal model, medical negligence requires that a cause-and-effect link be identified, and that one person’s action or inaction be the cause or agent of harm to another person.

Occasionally direct cause-and-effect links can be identified in health care, such as the surgeon who operated on the wrong (unobstructed) coronary artery on comedian Dana Carvey. However, most of the time, the cause of poor patient outcomes is unknown.

Our current system of medical malpractice (tort) requires that a wrongdoer be identified before they can “recoup the victim.” Without pointing to some perpetrator, the injured patient cannot be compensated. Since such identification is impossible in most cases, most injured patients cannot recover.

Because it’s based on the wrong model, the medical malpractice system, by its nature, reverses the doctor-patient trust relationship by instantly turning them into adversaries.

You cannot “tweak” such a system to work because the fundamental concept on which it is based, tort law, is not applicable to health care.

When health care providers are presumed guilty until proven innocent and treated as ‘criminals’, their noble calling has completed its painful transformation. job.

How did my vocation become a job?
The answer to the title question is simple. People and providers live in the 21st century. Healthcare is still back in the 19th century. Each part of healthcare (the system) and healthcare (the service) has changed, radically and independently, while the system itself has remained static. The system didn’t adjust because it can’t. Health care is not a complex adaptive system. It is a system in name only, a system without a systemic character, a non-systematic system.

The root cause or primary etiology is the lack of systemic. That is what we need to cure and we will do it in Part IV.

Deane Waldman, MD MBA, author of “Uproot US Healthcare,” your personal guide to healing patient care.