Trust
Medical Care, PediatricsThe real reason people no longer trust doctors is money. We’re likable enough, well intentioned enough, but we’ve been slow on the uptake about how much the financial part of medicine has come to dominate the mission part. We’re supposed to be applying science to prevent and ease suffering but now it takes more time to for a patient check in to my pediatric office than it takes to figure out what’s wrong. Once we figure out what’s wrong, we enter into a game of Mother-May-I, to see what treatment their insurer will allow.
Money has become too important because hospitals and doctors have been successfully played off against each other and we have too much debt and too little leeway. Many hospitals and doctors have been pushed to the brink and then over. We have this hospital pitted against that hospital; primary care against specialists. We are forced to prove our worth with RVU’s, managed care, meaningful use, and quality metrics that have nothing to do with the quality of care. Each one of these measures and a host of others have added billions of dollars to overhead and the cost of care. They have been sold as ways to decrease unnecessary care and control costs but have done exactly the opposite. No one mentions that there’s not an ounce of science behind these metrics or that the people establishing them have had little or no medical training. We have been divided and conquered and so have our patients; the well insured against the less well insured and the uninsured.
Once upon a time what you needed to get insulin was diabetes. Now you need good insurance and enough cash to cover the copays. Tomorrow you will need better insurance and more cash and so will the doctors and hospitals who can still afford to treat you. Seventy years ago childhood leukemia became a treatable disease. Now, along with other side effects, most families end up broke. We conquered polio with science for pennies a patient in the 1950’s. Now we can’t treat treatable infections because the necessary drugs are too expensive.
Doctors now spend less and less time with patients and more and more time as data entry droids who are slaves to more and more expensive Electronic Medical Record systems. We’re forced to do many hours of work that serve no purpose. We’re more depressed and less able to effectively address the things that bother our patients. If we’re no longer taking care of patients, why should they trust us?
We should stop the bleeding and stop throwing good money after bad and start using it for patient care.
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