By ALLAN DOBZYNIAK, MD
Could it be that medical care is now taken for granted? Are the fantastic technologies, miracle drugs, futuristic hospitals, and finally even doctors now simply viewed as facts of nature, things that were always there and will always be there? Is there the expectation that doctors will forever improve the quality of life and add years to it?
Could it be possible that government intervention into healthcare was the origin of the concept that patients need do nothing to earn their medical care and even presume perfection and cures? All they needed to do was wish it, demand it, and the government would decree that it happen. Could this thinking now be leading to the rise of a generation of patients who expect medical treatment and cures as a right simply because they wish it?
Was it not in the recent past considered above all important for physicians to have the ability to think and judge, to consider the countless variables and options relevant to the individual uniqueness of each patient, process the sum total of the information and render his or her decision? Of course physicians appreciate there are general approaches to the work-up and treatment of a variety of illnesses captured in so called “evidence based medicine,” with algorithms and protocols generalized from population groups. But if new physicians are taught excessive reliance on such protocols or if compliance with them is demanded, does this not inhibit clinical judgement? Do knowledge, experience and even intuition no longer have a role? Isn’t every patient an individual, and aren’t all protocols and algorithms based on the average typical case? It is actually quite easy to standardize statistical protocols, but not at all easy to standardize patients.
Such protocols were introduced as “helpful suggestions,” but they have now become rules firmly attached to the system. Hopefully the degree to which young doctors are being trained to follow protocols is not resulting in such a degree of command and control that this approach is now considered normal. To have such a system mandating physicians to devoutly comply with mandates demanding adherence to guidelines and protocols that excludes creative medical thinking must compromise diagnostic and therapeutic excellence. This will, as well, crush the pride and individualism characteristic of physicians. Such a profession will have a diminishing attraction for the brightest students. MACRA, ACO’s, hospital compliance mandates, EMR’s, all of which increase physicians work in many non-productive and aggravating ways, are filled with more and more guidelines, protocols and mandates.
The power of hospital administrators, insurance company executives, government bureaucrats and other power brokers that increasingly control physicians’ fates have imposed such fear in physicians that “keeping one’s mouth shut” has become the rule.
So we now have a clash between government and the expectations it has indoctrinated into a growing populace with the medical profession and its 1500 year traditional culture. There is little to indicate that physicians can win or even mount a competitive effort. If the “practice” of medicine, a craft, is replaced by obedient protocol followers, a profession will have been replaced by just another occupation. What a pity.
Some will hate the quote of Dr. Hendricks in “Atlas Shrugged” simply because the philosophical novel was authored by Ayn Rand, but I think it worth quoting anyway. “Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it – and still less safe, if he is the sort who doesn’t.”