Physicians are losing their authority, a power they once had in abundance. If you’ve been reading this blog for a while, you may remember that I touched on this topic when I dissected the exorbitant costs of our current medical care (click here to see that article). As I pointed out there, the days of authoritative physicians began to erode when the government got into the medicine business and began paying doctors and hospitals for treating indigent patients who earlier had often received free care. Yep, with government money comes government control (not to mention administrators galore). Nowadays, doctors bow to others.
I was reminded of this as I read a review of a new book (If I Betray These Words: Moral Injury in Medicine and Why It’s So Hard for Clinicians to Put Patients First. Find the book here). The physician authors describe what many of us already know, namely that today’s physicians are seeing more patients, in less time (have you ever felt rushed while speaking with your doctor?), that doctors now rely on fewer support staff (but again there are administrators galore), and of course they mention the familiar bugaboo, required technology. (Yes, doctors hate looking at those computer screens as much as you and I hate them doing it.)
How did this happen?
The history is clear. With the increasing regulations requiring doctors to supply more and more paperwork (from both government and the growing insurance industry) doctors began spending more and more time “complying” and hiring extra staff to generate the required paperwork. This became so unbearable that many physicians in private practice began giving up and joining groups that often were run by hospitals, who saw huge profits in the deal. And, once being in charge of clusters of physicians, hospital administrators began squeezing their doctors to see more patients, and often to order more tests, and whatever, to increase earnings. That squeeze continues.
Doctors exhausted and cynical
As the reviewer of this book summarized, “our healers feel exhausted, cynical, alienated and ineffective.” However, it is important to note that the authors do not call these doctors “burned out,” which might suggest physicians are not resilient. Rather they claim that doctors suffer from “moral injury,” thus implying the overall system is at fault, not the physicians. FYI: This review appeared in the 4/5/23 addition of the Wall Street Journal (see here). Here is a telling excerpt:
“No matter how [physicians] respond, they are all victims of a profit-generating machine that has taken over healthcare.” Profit and nonprofit hospitals, “motivated largely by revenue,” cut staff, increase physician work hours, hijack physician autonomy. (It’s true, when I first made rounds in hospitals over 50 years ago, doctors were confident and clearly in charge of their domain. How times have changed. I’ll say it again. Physicians are losing their authority.)
Partners in crime?
Somehow those profit and nonprofit hospitals remind me of the colleges and universities I discussed in my previous post. Why? Because those colleges and universities started their exorbitant increases in tuition when the government began supplying funds for college students to borrow. With more cash available to students, these institutions were happy to sop that cash up, getting rich as their students wallow in debt. (click here if you haven’t seen that post). So the villain in each of these cases appears to be none other than the Federal Government.
“The most terrifying words in the English language are: I’m from the government and I’m here to help.” President Ronald Reagan
