August 2, 2019
As a once-upon-a-time journalist, and to some extent a propagandist, I was very sensitive to and suspicious of this linguistic trick when it was first applied by those in government who favored Kaiser’s HMO model, what, forty years ago ? Sure enough, within a year, insurers began encouraging and covering visits to “providers” with training one or two orders of magnitude less intense and extensive than that of physicians.
It has been the frog in the pot-of-water-heated-gradually ever since. Physician-control over “health care” (which used to be called “medicine”, remember ?) was taken over by stealth, and the standards, methods and means of rendering medical care was relinquished by doctors themselves into the hands of the business class.
Keep in mind that Business Ethics is the prototype oxymoron.
When I worked for a large airline as the director of one of its busy regional medical departments, I had a decade to ponder the question of who, in a business hierarchy, it the “boss”. After about 30 years in private practice, and the last 20 as a solo practitioner, I was able to conclude that the person who tells you how you will spend your working hours and can hire and fire you is the boss, no matter how exalted your title.
Not too many decades ago it was illegal in my state for a corporation to practice medicine. A good call, because if a patient walked into my office with the personality characteristics displayed by the average corporation, I would, as was suggested by a famous Canadian film documentary, diagnose him or her as sociopathic.
Those who coveted the control of doctors over medical care have followed a clever strategy, because by gradual encroachments they have avoided provoking doctors into a direct confrontation of powers, in which they would have lost. And they have trained a generation of doctors in the submissiveness that will prevent them from ever reclaiming what was once their profession. By preferring to concentrate on the technological aspects of medicine and the satisfactions of patient care, physicians have now become incapable even of understanding the concept of a profession, much less of being able to reclaim their own. Because, as people who have always tried to please their parents and their teachers, they are constitutionally incapable of doing anything that would incur the displeasure of patients or authorities – or virtually anyone.
Someone once said that other than direct force, which I do not advocate, the only power we have over others is to withhold ourselves from them. It is because of this that the STRIKE has been the driving force of the union movement. But thus far, physicians have been unwilling, except in very isolated cases, to strike in order to resume control over how they spend their time and to what standards of care they will respond. As a consequence, 60% of their time is consumed proving to people who are incapable of understanding their explanations, that they have reasons for what they do.
Ironically, because doctors are forced to waste that time, they no longer have time to spend with the patient, listening, thinking, and explaining what is going on and what needs to be done.
We have become the “providers” they wanted us to be, and now we provide CONSUMERS with the products of the limited imaginations of our bone-ignorant bosses. We provide what THEY, totally untrained in medicine, THOUGHT medicine was providing. And we have given up what was, unbeknownst to them, the essence of our professional value, the healing relationship we had with our patients, and the unbending adherence to our professional standards of care.
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