How We Got Here

I’ve been an emergency physician for almost two decades now and can honestly say I’ve learned to distrust our American Healthcare System. It’s not because I doubt the level of education of doctors but because less than a quarter of the cost we pay is for care provided by physicians. It is because it’s virtually impossible to not to have to pay the balance: ultimately, we pay to be made to feel happier over  healthier.  The system does not value the time physicians take to listen, but rather rewards ones that focus on efficiency of time. It discourages the ones that are transparent, empathetic and honest, while rewarding those that only pretend to be kind. Turns out you can easily force professionals to kowtow and appease if you treat them as expendable employees. Those are also some of the “whys” to the loss of respect in the medical profession:  our system no longer values the integrity to say “no” but rewards doctors for saying “yes,” even if it might cause harm. Finally, the system we have in place blames those same professionals for the ill effects of the behavior it engenders once the fall out predictably manifests itself.

I started this blog as a way to translate some of the jargon and bring understanding and transparency to people, so that anyone can understand how problems like the opioid epidemic is the result of misapplied national policies in the interest of profit and a culture of greed, rather than ignorance or the work of a few bad actors or uninformed pill pushers. I hope to warn patients that jargon such as “quality measures” and “meeting benchmarks” increase profits do not our health.

We, doctors, generally know this because we are often also patients, or their family members or surrogate decision makers. Over the years, many of us in medical education have bent the ears of students, residents, patients, colleagues, family members, hell just about anyone who will listen about how critical ethical medical practice is to our health system and ultimately our own health. In future posts, I hope to share with you how our system deteriorates and only keeps from collapsing because a lot of great people know this at least as well as I do and risk their jobs, happiness and reputations daily to make it work, and a lot more that no one seems to want to admit. Here we go….


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