Health Care is the doctorpatient relationship, nothing more and nothing less. On an individual basis, it is that individual relationship. On a nationwide basis, it is the sum of all the doctorpatient relationships. An entire health care system has developed and continues to evolve in an effort to support these relationships. The businesses of medicine are a major part of our health care system, but they are not the medicine of medicine, which is the doctorpatient relationship. It is important to understand this distinction because the businesses of medicine exist to support and serve doctorpatient relationships. I believe businesses lose sight of this and make dollar profit the primary goal. In America, dollars are very important, and I want all necessary health care businesses to be very successful. However, a more compelling expectation can be developed by our health care business CEOs: the better achieved the ultimate ambition of unrestricted access to doctorpatient relationships for everyone living in America becomes, the more successful our health care businesses can be.
Sound, ongoing, non-conflicted and spontaneously functioning describe what a doctorpatient relationship must be. Sound indicates an extensive fund of knowledge and training, a going-out-of-your-way attitude, and a time-taking approach for investigation and explanation on the doctor’s part. For the patient, it indicates understandable delivery of information regarding the events which cause them to seek help; ability to listen to and understand the doctor’s questions and directions; and reliability at following these directions, taking the medicines prescribed and showing up for appointments.
Ongoing indicates the patient trying to see the same doctor over time and the doctor making an effort to be available even if there is no appointment scheduled.
Non-conflicted means no conflicts of interest entering into or pressuring the doctorpatient relationship, such as doctors ordering unnecessary tests just to make money, hospital administrators pressuring doctors to discharge patients before they are ready because hospitals are not paid on a per diem basis, insurance companies insisting on one form of treatment as opposed to a more expensive form, etc. Anything which interferes with the sincere functioning of the equilibrium of trust between the doctor and patient conflicts the relationship.
Spontaneously functioning indicates a spontaneity such as ability for the patient to see the doctor without a pre-arranged appointment when necessary and ability for the doctor to refer a patient to a more advanced specialist, whenever deemed necessary, absent pre-approval from the payer and absent the worry that the third party payer will count this as a black mark on the doctor’s record for spending more money. Doctors don’t work for the payer, they work for the patient.
The doctorpatient relationship is an employee —– employer relationship but not a typical one in that the employer, the patient, does not tell the employee, the doctor, what to do. Together, after exchange of information, two people decide how best to approach a problem. The doctor guides the relationship, but the patient must understand the proposed form of investigation and therapy and agree to accept the risks before proceeding. Perhaps there is more than one way of treating a condition. Then the doctor and patient decide which is best for that individual patient at that particular time. Effective communication is key, and for this to occur, the relationship must function in a sound, ongoing, non-conflicted and spontaneously functioning manner.
This idea of employee —– employer relationship is important. When some other entity is viewed as or in actuality is the doctor’s employer, allegiance can easily shift from the patient to that other entity. For example when hospitals employ doctors such as hospitalists, they might function in the best interest of the hospital and not of the patient. Insurance companies can do the same thing to doctors. Doctors should keep away from hospital and institutional employment and maintain independent practices.
A key part of a properly structured single payer is that the payer has zero influence over the functioning of the doctorpatient relationship. The payer administers payment of the bill but has no say over the work to be accomplished for which a bill is generated. An ongoing emphasis for this single payer has to be no interference whatsoever with the doctorpatient relationship either on an individual or a nationwide basis. This will be a tough pill to swallow for politicians, bureaucrats, health care administrators and business CEOs because they’ve never really understood that a relationship, an equilibrium of trust between two people not in their employ, is their guiding light. If recognition and full acceptance of this truth is not the touchstone for American health care, then the past and current failures in health care policies will persist, recycle and repeat.
Currently, the doctorpatient relationship is viewed as a tool by health insurance executives and hospital administrators through which and by the manipulation of they can enhance their dollar revenues. This is simply the wrong approach and, coupled with the arrogance, ego and reluctance on the part of some doctors to truly accept responsibility for their patients’ well-being, has resulted in the current miserable state of affairs for our health care system. Our delighted, self-serving, all-talk-no-action politicians use this sorry mess as a political football to be tossed back and forth in a never ending game of how long can I stay in Washington, DC and enjoy a position of elite entitlement at the tax payer’s expense.
The entire system needs an overhaul, effected by political, business and medical leaders who place the welfare of our country and its inhabitants above ideology and self interest and who wish to make our health care system the best in the world.
Obamacare is an atrocity put into law by garbage politicians.
R. Garth Kirkwood, MD