March 23, 2006

Wrong side of the fence

This (login perhaps required, sorry) is a good opinion piece about how medical care in the U.S. has become business-oriented and commoditized to the point where patients are treated as customers and no longer as patients. The physician writing the piece laments this, and urges patients to treat their doctors as their employees, and to "fire them" until they get the message - until health care improves.

This is a well-meaning position to take. The problem is that it's completely unrealistic for many people. I have to ask if the physician in question understands that. Let me offer a counterexample. I live in Cambridge, MA. I have health insurance, through my employer, and in that am fortunate. I have a primary care physician - however, that physician is mostly retired now, and spends a good portion of the year on the West Coast. I have been trying to find a new primary care physician whom I can relate to - one whom, in this piece's turn of phrase, treats me like a patient.

I have failed miserably.

Not in finding one who will treat me like a patient. In finding one at all.

In Boston, a city which some would argue is at or near the top of the medical profession heap in the United States, I cannot find a GP (General Practitioner) to take me on as a patient. I have spoken with seven over the past five months (or their staffs) on recommendations from my insurance company, my current physician(s), and friends. All have told me the same thing - their practices are full. One was unusually candid - he told me he was ceasing to practice medicine for insured patients, and moving into the realm of 'boutique' medicine - essentially becoming a doctor 'on retainer' for wealthy patients who could and would afford to pay premium prices for personal (i.e. 'patient') care.

We, the patients, are not the 'employer' of the physicians anymore. The HMOs and insurance companies and hospitals, etc. are. We are the customers of those businesses. There is a disconnect between we who receive the services and the doctors who provide it - and like so many businesses where there is a non-present middleman, that middleman is screwing with the provision of that service.

I'm not saying that there isn't an infrastructural cost to providing medical care which doctors alone cannot support. Hospitals cost money. Research costs money. And so on. However, there is a problem - and the advice to 'find another doctor' simply isn't tenable advice in some cases, because there aren't other doctors - at least, other doctors who aren't simply going to look at you and shake their heads and tell the insurance company, or HMO, or their hospital scheduler to simply send in the next patient to fill up those precious scarce minutes.

Posted by jbz at March 23, 2006 3:59 PM | TrackBack

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