I was thinking about TV programming and health care. For physicians, it seems that perhaps the shift in television shows reflects a shift in our view of physicians. Aside from a show like, “Grey’s Anatomy,” televised programming of doctor dramas or comedies, have pretty much disappeared.
Those old-time stories of the dedicated, selfless, brilliant physicians healing patients, with rarely a word about finances, unless it was in defense of treating an individual regardless of wealth, are no more. These shows have become hopelessly old-fashioned and would raise little more than a laugh from most consumers.
From, “Marcus Welby, MD,” to, “St. Elsewhere,” to, “Chicago Hope,” to “House,” few consumers view their healthcare providers with the trusting reliance on their expertise, their goodwill and their unadulterated concern for their welfare that typified patients visiting the fictional characters in these shows.
Today a program about the selfless healers of our society would be as out of place as a television show about the dedicated “public servants” of government or a show about “philanthropic insurance companies,” or one about the “dedicated healing of pharmaceutical companies.”
It’s a curious loss of mystique for one of the few professions that somehow over the decades of healthcare debate managed to retain its aura of being more about people and their health than the money.
Naturally, physicians have always been well compensated in our society, but the preoccupation with money and healthcare, codified into law by Obamacare, has finally brought physicians into the healthcare system as equivalent stakeholders, lobbying, asking, threatening, raising prices much as pharmaceutical companies and insurance companies do as they pursue their financial interests.
Sure, a physician might say, “But if you get sick, you’ll be willing to give anything to get your life back,” which is true, just as it might be about getting a prescription you need, but reveals more about the priority of a profit interest and proves the statement about their similarity to other stakeholders rather than disproves it.
For consumers the loss of physician mystique is reflected in more than the change in television shows. We are encouraged to not only inform, but ask questions of our physicians, highlighting the fact that these interactions are CONSUMER transactions.
The government encourages such communication between us as consumers of healthcare in videos such as, “Please, Ask Your Doctor,” which can be found on YouTube and encourages us to “…ask our doctors questions like we are buying electronics,” http://www.youtube.com/watch?v=DTo_KS88D1I.
We are encouraged to report fraud or suspected fraud on the part of our healthcare providers and we’re informed about billions of dollars of such fraud estimated each year, mostly from healthcare providers, hospitals, doctors, NOT patients (naturally, undiscovered fraud is not counted and therefore only estimates are possible).
The AMA informs consumers that physicians “…drain between $70 and $126 billion out of the health care system each year,” for defensive medicine (http://www.ama-assn.org/resources/doc/health-care-costs/medical-liability-reform.pdf) because physicians pay large amounts in malpractice insurance and other protection against getting sued. For a long time this concept was largely supported that physician fees were high in part due to these premiums and because of our “litigious” society.
Yet, the argument is less persuasive as consumers read that malpractice insurance premiums dropped and continue to drop (“Competition driving malpractice premiums down,” 11/25/13, Jeffrey Bendix, http://medicaleconomics.modernmedicine.com/medical-economics/news/competition-driving-malpractice-premiums-down-0) and still defensive medicine remains a cost to consumers and fees for physician services continue to rise.
Obamacare has brought into glaring spotlight the fact that healthcare in the US today is about money first and sometimes only, and stakeholders’ interest in it, and what they’re willing to do to get it. But because of the pedestal on which we placed physicians, perhaps their descent into the money grabbing group is the change that is the most noticeable among stakeholders and promises to most change the interaction between patient and physician.
Each of us in years past would rarely if ever hear of someone who didn’t fill a prescription or who did not get yet another “recommended” test from a physician. Today, it would be unusual to meet a person who had never declined to fill an expensive prescription or who said, “No,” to yet another test.
Each of us in years past might be astounded at what we were charged for 10 minutes of physician time, and assume it would be the same anywhere, but now, increasingly we know that there is a huge difference in what is charged by different healthcare providers. This transparency is supported by Obamacare and technology enables consumers to go to Healthcare.gov https://www.healthcare.gov/where-can-i-find-provider-information/ and compare providers, hospitals, nursing homes or home health agencies and prices.
Our physicians have gone public with their bill-collecting role and strategies. There are many articles and much advice from physicians to other physicians on how to collect their fees. This is partially the result of Obamacare and its inclusion of insurance products that leave patients paying for enormous amounts of medical bills out of pocket, or that are uncovered under plans such as the less expensive bronze or catastrophic plans. Likely today patients will try to negotiate bills they cannot afford, or will publicize their dissatisfaction with non-network services for which they receive bills or balance bills from providers.
Physicians underscore their money concern through articles about bill collecting, practices that require a credit cards from patients, or those that perform credit checks. Now comfortable with discussing money, we see groups of physicians threatening not to take Medicare, or those announcing they’ll not accept any form of health insurance, or those who will shift into concierge medicine decisions all justified based on money, solidifying the physician-money connection in a very clear choice of money over patients. This too hammered a nail into the coffin of physician mystique.
Today’s physicians made a choice based on their need or perceived needs for money of certain levels. Instead of their traditional and though often fictionalized reputation as being somehow apart from other greedier elements of the healthcare system, today it's more clear that they have joined the ranks of other stakeholders such as insurance companies and pharmaceutical companies who though also arguably can do good for people have also arguably taken advantage of their right to charge whatever the market will bear.
It’s not in all ways bad for consumers. It was likely always silly to put such unquestioning faith in and attribution of such saintly impulses on the medical profession. A little reality will allow us to make better decisions and relate to physicians as other professionals whose services we require. It will also allow us to push for controls on what we’re charged by all stakeholders in the healthcare system so that insurance companies don’t continue the ever-continuing race of, “We charge more because they charge more.”
For physicians it won’t be all bad either since our expectations of physicians are more grounded in reality rather than some idealized version of “doctors,” and their skills.
