The Hierarchy of Ends in Our American Healthcare System

What are the ENDS of our American healthcare system? Since the word, end, in this context means a goal or result that one seeks to achieve (The New Oxford Dictionary of English, Oxford University Press 1998), I guess it depends on whom you ask. I am going to list three rather obvious and important ends for our system, and I ask you to think about them and decide their relative importance, their rank in a hierarchy of ends:

  1. , the doctor  patient relationship, which is an equilibrium of trust developed between two people through which clinical decision making regarding the patient’s illness can occur,
  2. $$$$, which indicates a profit motive for the businesses which function within our healthcare system. These businesses include hospitals, health insurance companies, drug & technology companies, nursing homes, and on and on. Note that doctors’ practices are also included,
  3. Careers & employment, which includes doctors, nurses, technicians, administrators, malpractice lawyers, lobbyists for the healthcare industry, and many other types of positions, which somehow relate to our system of health care.

How do you rank their importance? What is the hierarchy of these ends? I believe that most doctors and patients would rank them in a certain order, while insurance company, drug & technology company, and hospital business people would rank them differently. And finally, those who are employed by our healthcare system might rank them in yet a different order of importance.

I suggest, since the citizens of the USA and some of the non-citizens provide every penny of the MEANS (money), which is the financial base making possible the existence of this system, that they be the ones who decide the hierarchic ranking of these ends. Then maybe a system, which truly tries to achieve the meaning of patient-centered care, i.e., sound, ongoing, non-conflicted, spontaneously functioning doctor  patient relationships, could be developed, as opposed to the “solutions” offered by the poisoned, agenda-driven, greed-driven rhetoric of ALL of our politicians.

How do you make something like this happen? Once they get elected, the politicians quickly forget who elected them, abandon the glorious rhetoric from their campaign messages, and sit in Washington, DC and in fifty state legislatures sucking off the government teat. Take a look at Jack Abramoff on the TV Show, Sixty Minutes,

How can we effect real solutions?

R. Garth Kirkwood, MD

The Doctor Patient Relationship

Some of you who read these essays may wonder why I place this symbol, a bidirectional arrow, between the words doctor and patient, when I write the phrase, doctor logo patient relationship. If you can remember high school chemistry, it is the symbol for equilibrium reactions. And this is how I view the doctor logo patient relationship, as an equilibrium of trust between two people. The symbol tells us that the relationship is a two way street allowing the mutual exchange of information, the mutual development of trust, and the delivery of and receipt of medical care. The figure shows the interplay of what I think are prerequisite characteristics of doctors and patients for the development of successful relationships through which good-quality medical care can occur. It is also figure 3 in my book, Equal Health Care For All, published in 2007.

I had received some suggestions for this figure when I was writing Equal Health Care For All. One person suggested that honesty be added to the figure. I believe that I would be on firm ground if I added honesty to both columns. But because I think honesty has to, by definition, permeate an entity called a mutual trust I didn’t write it out. Another person suggested that warmth should be added to the doctor column. Again, I didn’t write this out specifically because it seems to me that if the doctor brings those listed characteristics into play that must mean there is some measure of real underlying warmth.

I am sure other people can come up with a figure or diagram and a list of attributes equal to or even better than my list. The important part of this would be that they are actually thinking about it. Give it a try. Figure out what you want from your doctors and your patients and what you must bring in your effort to develop sound, ongoing, non-conflicted doctor  patient relationships.

The statement which this figure does not make and which seems obvious to me and, I think, to most patients is that this relationship is SACROSANCT, not to be trespassed upon by anyone. A major problem in America is that people, whose careers happen in the business of medicine and in politics, do not seem to understand this. Whether they truly do not comprehend the effect of their machinations for increasing profit and for garnering votes, financial campaign contributions, and other favors on the the non-conflicted functioning of the doctor  patient relationship or have decided that this relationship is a tool for them to achieve their goals is not clear to me. Maybe it’s a combination of both in this arena. But I tell you that if it doesn’t stop, there can be no true healthcare reform because health care ceases to be the objective of that reform.

I suggest that you read a couple of other recent articles about this. I provide the links below. Read these pieces carefully and think about them. It’s your healthcare system, and you pay for it completely regardless of what type of 3rd party payer administers payment of the bill.

  1. ObamaCare’s Lost Tribe: Doctors by Daniel Henninger in the Wall Street Journal.
  2. Playing Politics with the Doctor—Patient Relationship by Deborah J. Oyer, MD in the New England Journal of Medicine   Here, it’s also worth the time to investigate the two references for their information. Just click on references and links are provided.
Take the time to read, think, and learn. Form your own opinion. Then badger the politicians until they get it right. When they ignore you, remind them that November is rapidly approaching.
R. Garth Kirkwood, MD