ON MEDICINE: Leaders Or Followers

By ALLAN DOBZYNIAK, MD
The solution to healthcare’s costs and access problems is quite obvious. It has been repeatedly suggested that what is needed is a plethora of doctors. Of course this would lower cost and increase access. “Overpayment” of U.S. doctors would disappear as the market becomes oversaturated. Access to care would no longer be an issue as doctors compete for patients.

Only a few minor adjustments would be needed. Time and cost as barriers to manufacturing legions of new doctors could be rectified by eliminating the non-essential four years of college and the extraneous liberal arts courses. A year or so of several science courses in the local community college should suffice. Once in medical school, students could be indoctrinated to give up their rights and self-determination for the general good. Compromise as an approach to regulatory serfdom could be declared one of the most laudable qualities. The chorus of righteousness and the PR mumbo-jumbo of “openness,” “caring,” “sharing,” “community,” and “compassion” could be further integrated into the curriculum. Being taught to think like thinking machines would be pursued. Following the protocols and checking boxes in the myriad screens in the EMR to satisfy the masters of the very “moral” RVU invention would relegate thinking to mere coincidence.

These liberal arts degrees that teach future doctors to think critically, ask the right questions and effectively advocate for patients would be rendered antiques of the past. Can it really be justified to study philosophy, ethics, logic, humanities, ancient and modern literature, and history in a liberal arts curriculum? After all, the result might be the production of doctors who can think and who might also recognize what is good, true and even beautiful.

If a bounty of doctors would lower costs, one wonders why the greater density of physicians on the West and East coasts is far greater than in the interior of the United States, yet the costs of healthcare are much higher in these locations. Such facts should be ignored, even when knowing it is the price rather than the number of inputs into the system that creates the expense. Could it be that hospital administrators with, at most, a master’s degree having a median annual income of greater than $750,000 that contributes to hospital costs and the nasty economic price reality?

But maybe the compromise philosophy is not all that great either. If the goal is more control over physicians, no amount of compromise will ever be enough. Little by little, inch by inch, each small move seems like an insignificant compromise, only to wake up some day to the realization that you have compromised your rights away.

Once critical thinking has been discarded, the mushy consensus-driven group too scared of disagreement or power to speak truth to gibberish can feel secure and fulfilled as they follow the herd. The majority opinion coupled with peer pressure, even if such opinion is inaccurate or nefarious, can result in compliance with the group-think allure. Cognitive thought quite often produces one or few dissenters. If this caught on as the prevailing culture of physicians, members of the profession continuing to compromise, actually giving up and losing, might perhaps change. But of course physicians are never allowed to offend anyone, and they must give in. Why, because physicians’ morality as encompassed in ethics and professionalism has been weaponized against them. Never should passivity be confused with morality.

Just speculate on the state of the medical profession when the “dissenters” are finally silenced. Any remaining struggle between the profession and those who want to control it will be no more. This is an existential struggle whose outcome is still somewhat dependent on the choices physicians make, if they are still able.
Maybe then producing large quantities of the proposed “newly minted physician type” may not be the best answer.

2018-06-11T15:50:13+00:00