Complaint Day

Years ago, when the San Jose, California area had GM and Ford automobile assembly plants, I would see patients who told me that they hated their auto assembly jobs.  They said  that they hated the work and the systems in which they were working. They hated having to spend their lives installing the right front tire on every vehicle that came down the assembly line. They hated their dehumanization (my interpretation, not their word),  inability to make decisions and bring about change. They hated the imposed  industrial metrics which governed their work and lives.

Now, I receive complaints about medical care from a variety of  people throughout the country.  Their themes reflect their perceptions that the people who provide their medical care have issues similar to the auto workers I described.  I interpreted their experiences differently from the way they interpreted them.  The common theme for them was failure to receive care, interest, attention and proper treatment.  My interpretation focuses on two issues, business arrangements and professionalism which I believe underlie many of these complaints.

When a physician sends a patient off without taking an adequate history, without performing an appropriate physical examination, and without offering an evidence-based diagnosis and treatment plan, that physician is unprofessional and has not fulfilled his or her responsibility to the profession, to the people who have established a governmental licensing authority providing a franchise for that doctor to provide professional care, but most of all, to the patient who, with a mixture of anxiety and trust, has come to that physician for professional intelligence, wisdom, insight and understanding.  Patients are defenseless  against the professional's "brush off," lack of concern, lack of skill and lack of interest or distractedness.  Unfortunately, for those physicians - and most of all for their patients -  what should be an intellectually challenging and engaging work has become a 9-5 job.

Factors shaping the health care profession which affect providers, patients and payers, include  the "businessification" of medical care.  What was once a single-practitioner or small group practice, marked by strong identification with the quantity and quality of care provided to patients and pride in shared practice skills, now will often be a large multi-location multi-specialty group, operated or controlled by non-physicians,  with standards for practice essentially set by highly-paid non-medical administrators and business personnel enforce those standards through highly paid and carefully placed (and controlled) medical administrators (i.e., directors and department chairpersons) .  The financial bottom line offsets the real quality of care (not the advertised quality of care).  The choice of ancillary staff, productivity per doctor, cost per square foot of space, equipment, range of services, and scheduling have been removed from physicians' decision-making. Marketing-oriented questionnaires substitute as measurements of quality. Return on investment, rather than life-changing high-quality of care, is the measure of effectiveness and efficiency. Your health care has moved into the industrial metrics and control era.  It's not the government's fault. It's our fault.

Quality of care can be measured, but why should anyone bother? If an insurer has a new group of patients every year, why invest in care which may initially cost more, but save their competitors money when, in later years, they inherit the patients on the basis of their "low" insurance premium bid.  If the physician's pay and recognition depends more on the amount of revenue generated than the actual quality of care he or she has provided to non-high-profile patients, the physicians become ground down,  their professionalism suffers and they have neither time nor interest in dealing with your complex medical issues in a 10 minute time slot.

We know what happened to GM and Ford and previous GM and to the sad owners of their industrial-metric produced cars.  What is going to happen to you and your family under the industrial approach to health care?