The Dr. Is In : The Big Business of Medicine

Dr. Jahn weighs in on the modern healthcare system and the dangerous pitfalls that come with business, not your health, taking precedent. Read on to find out how you can take better control of your healthcare in this landscape.

 

As you digest the articles in the issue about social media and branding, I thought I might write an editorial-style column to alert you to the sobering realities of how medical care has changed (spoiler alert: not for the better!), and how you as a patient, might navigate this brave new world.

The historic purpose of medicine has generally been to cure illness and alleviate suffering. While it has certainly not been always successful in this endeavor (the story of medicine has had its share of  scoundrels  and questionable cures),  its general purpose has been to take care of the sick and restore health.

 Physical and mental illness were both seen as aspects of illness, and attending to both required someone who could deal with the entire patient, body and spirit. No surprise that in ancient days, medical practitioners were also priests or shamans: restoring true health meant attending to the patient on all levels. Until not long ago, medicine was considered a vocation, and even today it is referred to as a profession. Like a profession of faith, medicine was not a job but a calling. 

Enter Big Business. Put aside for a moment those noble concepts of freedom, equality and opportunity: what America is best at is making a profit! Business is the constant thread running through our history. And the essence of business is turning a profit. This, in turn, hinges on one sacred principle: sell things for more than they cost. And the key to maximizing profits is to reduce cost to a minimum, sell for a maximum, and hide what you have done.

Whatever you might think of my analysis, one thing is clear: applying the “business model” to the practice of medicine is a poor fit. It not only damages the quality of medical care, but fundamentally refocuses its purpose from taking care of patients to taking care of stockholders.

Let’s look at some of the specifics in the process. Doctors have historically been fierce individualists, running their own practices. As physicians, they have held a monopoly on medical care, and their fees were set by their own professional organizations. To gain control of doctors, the first priority of “business” was to demolish this monopoly. It began with insurance companies. Insurance is essentially a business gamble, based on the assumption that the company will make more money from your premiums than they will have to pay out. The more healthy young subscribers, the more they profit. If the proportion of ill subscribers increases, they raise the premiums. And if you are a real liability, with chronic and serious illnesses, you become uninsurable. The insurance companies always win. 

Next came a more direct attack on the physicians’ domain. Ancillary professions, such as nurse practitioners and physician’s assistants joined the practice of medicine, and became clumped together with physicians under the  generic label of “health care providers.” While such health care workers provide excellent service as part of a medical practice, they are not physicians, and lack the same diagnostic or therapeutic expertise. But they cost less, a sacred tenet in Big Business’s quest to maximize profits. This has now reached a level, outrageous in my opinion, where during your “doctor’s visit” you may never even see a doctor!  Diagnoses are boiler plate, treatment is scattershot. Almost every patient who goes to a walk-in clinic gets antibiotics and steroids, and the amount of time and effort spent on taking a detailed history and examination is reduced to a minimum. But the profits keep rising.

The next business tactic was to gain actual control not only of “health care providers,” but also the customers. Since primary care physicians control patient referrals to specialists, hospitals are buying up primary care practices in order to keep these referrals (and profits) within their system. The individual medical practitioner, primary care or specialist, is a vanishing breed, as more and more doctors join large groups controlled by businessmen and Boards of Directors. Many high profit specialty groups (such as dermatology) are simply acquired by investors and treated as a business asset. 

And this is where “branding” comes in. Applying the concept of “brand loyalty” to medicine is an odd fit. It takes away personalized attention and care, and reduces “health care” to a commodity. With brand loyalty, individual physicians finally vanish, and the Logo takes their place. You drink Pepsi, you drive a Ford and your hospital Brand is…? 

And with all this, the practice of medicine has fundamentally changed. Profit, not your health, is the goal. More patient visits per hour, more tests and more procedures make more money for shareholders than time consuming and thoughtful individual care. Medical care has become a commodity.

So what can you, the individual patient, do, given the dystopian medical landscape that is upon us? 

I would first recommend that you find a good primary care physician. This may be an old fashioned doctor who does everything, or a newer fashioned doctor who mostly refers out. But the common quality is this: they need to listen to you! Don’t accept fast-food medicine, one size doesn’t fit all. Find someone with whom you are comfortable. No physician knows everything, but the ideal doctor is one who knows what they don’t know, and takes the time and effort to refer you to the appropriate specialist, who does. 

Next, get a diagnosis, and gather information. Although the internet is a potentially tricky place, look up your condition on some reputable websites, such as those of major academic centers such as Harvard, the Mayo Clinic, or the National Institute of Health (NIH), and  learn about your problem, what it means, what the treatment options are, and what the expected outcomes might be. 

To get the best health care, remember you’re not dealing with a branded commodity, but your own precious health, and you need to be knowledgeable to get the best care. And while you may buy hot dogs based on label rather than contents (what exactly goes into hot dogs anyhow?), this is different, although Big Business would have you believe otherwise. 

Finally, shop around. Branding, and brand loyalty does not serve you as a patient. Every medical institution has medical practitioners who are outstanding, and others who are not, regardless of the logo on their white coat. Don’t let Big Business commoditize your care, and your health.

Anthony Jahn, M.D.

Anthony Jahn M.D. is an otolaryngologist with a subspecialty interest in ear diseases, disorders of hearing and balance, and disorders of the voice. He is a professor of clinical otolaryngology at Mount Sinai School of Medicine and is the noted author of Care of the Professional Voice. For more resources, go to his website www.earandvoicedoctor.com.