The great thing about medicine is that it’s a caring, noble profession. You can diagnose and cure things that make good, honest, hard-working people miserable. One can save lives, alleviate pain, lift depression or otherwise improve the lot of one’s fellow man (and woman). Of course, that’s on a good day. On a bad day, one might gladly trade one’s job for a career in aquarium sanitation. Or dream of designing novel punishments for deserving bureaucrats. Think of it living a life as Dr. Jekyll and Mr. Chap-My-Hide.
The bad thing about medicine is that – at least in the United States – the good days are growing fewer and fewer each year. It’s not the patients. People are pretty much the same from one generation to the next, and so are their problems. Instead, it’s “the system” that has gone amok.
Once upon a time in America, roughly 20-30 years ago, doctors were pretty much educated, trained and then expected to do their job. It seemed like a good idea at the time. After all, if there were people who were better trained to take care of patients then they’d be the doctors, right?
“This feels serious. We’d better get the insurance company’s pre-authorization review nurse to take a look and tell us which guideline we have to follow...”
Sadly, this is no longer true. No matter how good he or she is, your doctor is bombarded every day with dictates about what they must and/or may not do to diagnose and cure what ails you. These are enforced with whole hosts of complex rewards and punishments. That might be okay if the people behind the mandates knew you, knew your case, or even knew anything about medicine. But alas, this is rarely the case. Most often these faceless folks sit on government regulatory panels, in health insurance company cubicles, in lobbyists’ lobbies and other non-clinical settings – as far removed from the consequences of their decisions as possible. Along the way, they’re created the most expensive and least efficient healthcare system the galaxy has ever seen. (At least as far as we know. Who knows about what the Hubble Telescope may find next?)
How did it get this way? Like the proverbial “road to hell”, it’s mostly a result of good intentions gone terribly wrong. (Although let’s face it, there are plenty of greedy, powerful people and companies out there who have intentionally contributed to the mess for their own personal gain.) This blog is simply a set of observations on how those good and bad intentions end up affecting patients, providers and the people who pay the insurance premiums every day.
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