The Origin of Medicine

Nobody, not even hospital administrators; hospital board members; 3rd party payers; politicians; drug & technology company executives; or doctors, is at liberty to manipulate, obstruct, or interfere with the spontaneous, non-conflicted functioning of individual doctorpatient relationships and then claim patient welfare as their goal!

Sound, ongoing, non-conflicted, spontaneously functioning doctorpatient relationships are inseparable from the practice of medicine. Indeed, they are the origin and essence of it.

Healthcare administrators, politicians, and other functionaries in the business of medicine are qualified to make contact with individual doctorpatient relationships in exact proportion to their willingness to give up the dollar quest of their healthcare businesses: in proportion as their love of the essence of medicine, the source of and reason for their existence in this sphere, is above their rapacity.

These three statements are paraphrases of the three opening statements of Chapter 2, “The Origins of Liberty, Property and Justice” of F. A. Hayek’s book, The Fatal Conceit The Errors of Socialism. I substitute the doctorpatient relationship for several property.

R. Garth Kirkwood, MD

Control of Doctors by the Business of Medicine: The Conceit of Poisoned Rhetoric in Physician Compacts–Socialized Medicine

The business of medicine: hospitals, 3rd party payers, politicians, drug & technology companies, doctors’ practices, and others in our healthcare system are driven by the dollar bill. It is understandable; this is America. However, in my view, the practice of medicine is one arena in which the dollar bill should not be the primary driving force. Rather, sound, ongoing, non-conflicted doctorpatient relationships, supported by not supplanted by the dollar bill, should be the goal, which we pursue. Why? Because that’s where clinical decisions are made. These relationships are the proximal source of the work of health care. Dollar thinking should not be allowed to compromise the thinking that occurs within the mutual trust developed between the doctor and the patient. Is it possible to remove the dollar bill from doctors’ thinking? I think it is and I think this has to occur, if we are to have healthcare reform. Doctors themselves must acquire the discipline to put their own dollar earnings out of their thinking when they see patients. They also must possess the courage to say NO! NO! NO! to administrators of hospitals, 3rd party payers, politicians, and any others, who try to bring the poison of their business rhetoric to bear upon the functioning of the doctorpatient relationship. Let’s look at just one of a myriad of examples of this subtle business pressure which sounds oh so good but which is in reality poison for the trust, which must be developed between doctors and patients if sound, ongoing, non-conflicted health care is to be our norm: Physician Compacts with the medical centers, which hire them and pay their salary.

Here is the link to one of these: The Virginia Mason Medical Center Physician Compact:
Perhaps print a copy of this compact and then focus on the following sections under Physician’s Responsibilities:

    1. Collaborate on Care Delivery— Behave in a manner consistent with group goals. NO! The goals are decided within the context of a sound, ongoing, non-conflicted doctorpatient relationship. If the doctor wants/ needs help, it will be available. It’s called Consultation with other doctors, who are specialized in other areas of medical knowledge. Teams of professionals are assembled within medical centers to help bring the medical work, the decision making of the doctorpatient relationship, to fruition but not to assert group goals on this decision making.
    2. Listen and Communicate— Request information, resources needed to provide care consistent with VM goals. NO! Doctors listen and communicate within the context of sound, ongoing, non-conflicted doctorpatient relationships. Medical centers exist to enable that communication to occur but not to insert their own goals on top of it.
    3. Take Ownership— Focus on the economic aspects of our practice. NO! The doctors are not responsible for the medical center’s economic welfare. When this happens, clinical decision making becomes conflicted by those economics.

Let me ask a commonsense question. When you go to the doctor for a medical problem, do you want the doctor to base his/her decision making on their own dollar earnings, their own economic welfare? Of Course Not! This superimposes dollar conflict on top of clinical decision making. It’s the same conflict if the doctor has the medical center’s economic well being on his/her mind during the course of clinical decision making. And yet doesn’t this business rhetoric in this physician compact sound OH SO GOOD! ( Focus on Patients, Collaborate, Group Goals, Economics etc., etc.)

This business rhetoric is poison. It is one of the techniques socialists use to try to assert their authority and beliefs. (F.A. Hayek: The Fatal Conceit The Errors of Socialism Chapter 7). The business of medicine is socializing our health care by using the techniques of Socialism in partnership with 3rd party payers and politicians for their own end: Efficiency in Spending. That is to say, spend as little as you can to make it look like you’re delivering great medical care to everyone in your community while concomitantly lining the pockets of hospital administrators, helping to maintain the mega-profits of insurance carriers, and, of course, keeping the politicians happy! (R. Garth Kirkwood, MD: Socialized Health Care Reform). If you don’t believe this, try looking up the salary of some non profit medical centers’ CEOs, then decide if you think what I’m saying has any merit. This doesn’t conform to the strict definition of Socialized Medicine only because the government doesn’t own and operate both the financing of health care and its delivery in all of these institutions. But the end result is the same as that evolving from the pejorative context of the term, Socialized Medicine, i.e, fear of and fact of clinical decision making within the context of doctorpatient relationships being manipulated and controlled by someone else other than the doctor and patient to accomplish an agenda, which is not part of clinical medicine despite the best efforts of these someone elses to make us believe that it is.


Is there a solution to this? Yes, of course there is. Perhaps the most important part of the solution is for doctors and patients to just say NO! to the business of medicine. Doctors and their patients need to make it known to hospitals, 3rd party payers–private and public, and to politicians that the patient employs the doctor not them. The doctorpatient relationship is an employee-employer relationship. It is an unusual one, to be sure, because, although the ultimate power in the relationship belongs to the patient, the employer, (the patient has the choice of doing what the doctor recommends or not) this employer (patient) does not tell the doctor (employee) what to do. The doctor, based on his/her medical training and experience coupled with information from the patient, decides what is best to do for that individual circumstance. The patient can accept or reject the proposed plan of diagnosis and treatment but that does not put him/her in the position of guiding the relationship. The patient participates in the relationship, which is guided by the doctor. This is why TRUST is so important. For many reasons, some of which are doctor-generated, this trust has been lost in America. It needs to be resurrected. But I state this clearly and emphatically: Medical centers and others, who pay the doctors’ salaries, imposing their own business rhetoric on the clinical decision making of the doctorpatient relationship will not restore this trust. It will simply conflict the clinical decision making with dollar signs, $$$, and we will eventually wind up drowning in the green swamp called, The Big Dollar Pie. (R. Garth Kirkwood, MD Equal Health Care For All)

One other thought: Don’t let the medical centers’ hiring of physicians fool you. Medical centers have evolved for one reason: To enable the clinical decision making within doctorpatient relationships to occur. And their administrators’ proposals, MDs or not, do not supersede that individual decision making, which occurs within the context of sound, ongoing, non-conflicted doctorpatient relationships. Even though these medical centers pay the doctors’ salaries, patients and the American people in general are the original source of the money within the American health care system. Thus, they are the doctors’ employers.

I believe the following is a good and reasonable ethical position for doctors to follow: Put the needs of the patient above your own needs and above the needs of any group for whom or with whom you work. I believe physician compacts like the one discussed in this essay tear this ethical concept asunder. This business rhetoric is widespread across the USA in many forms and disguises:

  • Managed Care
  • Cost-Effectiveness
  • High Value-Cost Conscious Care
  • Evidence-Based Medicine
  • Shared Decision Making
  • Medical Homes
  • Bronze, Silver, Gold, Platinum Insurance
  • Consumer-Focused
  • Others.

Don’t be fooled. This is control and manipulation of the doctorpatient relationship. This disruption of the doctorpatient relationship is my definition of Socialized Medicine.

Virginia Mason Medical Center prints their agenda for everyone to see. Their administrators want to be in charge of health care in their institution. It’s a big mistake, but they make it sound so good! I wonder if they have any understanding of the fatal flaws of their own conceit.

R. Garth Kirkwood, MD

Socialism 101 Again

In my previous post Socialism 101 ( ), I left a link to the Virginia Mason Medical Center Blog, on which I tried to post a comment regarding a couple of their blog entries. I cannot find my comment on their blog, so I decided to record it here. First, go to the Virginia Mason Medical Center Blog and read the following two parts:



In the first, you will find the “Virginia Mason Strategic Pyramid” and, in the second, the text, “Being very clear about what it means for a physician to be a citizen of Virginia Mason is really the crux of it,” says Dr. Lammert, to both of which I referred in my comment.

You can also see their stragecic pyramid here:


The following is my comment, which I cannot find on their blog:

Your pyramid is politically correct rhetoric, which conceals the poison of what I believe you are trying to do: Hobble the spontaneous functioning of the doctorpatient relationship. The top of your pyramid is just wrong! Patients are not the top of the pyramid of health care. Rather the doctorpatient relationship functioning in a sound, ongoing, spontaneous, and non-conflicted manner is the top of that pyramid. The work defined by the clinical decision making, which evolves from the mutual trust between the doctor and patient, is what needs to be accomplished.
I note the following words from a previous post on your blog: “Being very clear about what it means for a physician to be a citizen of Virginia Mason is really the crux of it, says” Dr. Lammert. The definition of the word, citizen: a legally recognized subject or national of a state or commonwealth, either native or naturalized (The New Oxford Dictionary of English, 1998). So, doctors are the subjects of the state known as Virginia Mason. It’s a bit grandiose, don’t you think? Sounds like Socialism 101.

I understand now why you have placed Virginia Mason Production System as the base of the pyramid. Instead of recognizing reality, which is that Virginia Mason is just one of thousands of medical centers employing millions of people to help accomplish the work defined by the decision making which occurs within the framework of doctorpatient relationships, you place yourself as the very foundation of health care and view doctors as citizens of your state. It’s a load of crap.

R. Garth Kirkwood, MD

I wonder why they didn’t post my comment. Maybe, they can’t handle criticism, which demonstrates the poison of their rhetoric. Of course, let’s not let the medicine of medicine interfere with the business of medicine in this non profit business fiefdom, which records revenue of more than 804 million dollars in their annual report of 2009, and more than 836 million dollars for 2010

R. Garth Kirkwood, MD


The N Y Times Editorial, “Treating You Better for Less,” Equals Socialism

The New York Times published an editorial on June 2, 2012, “Treating You Better For Less.”
In the editorial, the Virginia Mason Medical Center in Seattle is noted for its rigorous internal reviews to eliminate waste and inefficiency. Now, doctors are required to click through a computerized checklist of the medical circumstances needed to justify a costly imaging test. So, the checklist is a block, an obstruction to doctors, who now must justify their clinical evaluations. Presuming that the doctors have absolutely zero financial interest in ordering the test, these are my thoughts:

First, an administration that is thinking of helping its doctors would clarify use of the checklist as an aid to look for reasons to order the test that doctors may not have thought of during their clinical evaluation (the history & physical) as opposed to making it an obstruction.

Second, money is the driving force behind these lists. Thus there is direct interference with the clinical functioning of the doctorpatient relationship because of the dollar bill. Practicing medicine with saving dollars on your mind is every bit as conflicted as the doctor who orders tests or does procedures solely because he/she profits from same. The latter is garbage medicine and so are these lists.

Third, to whom must the doctors justify their actions? Is it some administrator, who bows before the almighty insurance company? And who is it that constructs these lists? What is their knowledge base? Who pays the salaries of the people who construct these lists?

Fourth, this type of endeavor is SOCIALISM. These dollar based, greed-driven insurance companies, hospital administrators and others want the doctorpatient relationship to function in accord with some central authority, while pushing aside the fact that the essence of medicine and the reason so much medical knowledge has been accrued over time is the spontaneous functioning of the doctorpatient relationship.

Fifth, doctors conform because they are afraid not to, noting that GPs are much easier to manipulate than specialists because of the latter’s deeper fund of knowledge.

Sixth, this undermining effort to save dollars being a clinical modus operandi is now engrained in the medical consciousness of the USA by such clinically useless rhetoric as  cost-effectiveness, managed care, medical homes, evidenced-based medicine and other verbiage. Patients may not have a clue as to what is really happening!

Hurrah for Seattle! Remind me not to get sick, if I visit there. Something from Canada must be contagious!

R. Garth Kirkwood, MD