{"id":1063,"date":"2015-08-05T18:43:20","date_gmt":"2015-08-06T01:43:20","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=1063"},"modified":"2015-08-05T18:47:16","modified_gmt":"2015-08-06T01:47:16","slug":"medical-professionalism-vs-commercialism","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=1063","title":{"rendered":"Medical professionalism vs commercialism"},"content":{"rendered":"

\"fast-cheap-good\"<\/a>The history<\/a> of American medicine is the story of the rise and fall of a professional guild. \u00a0In the 19th and early 20th Centuries, physicians distinguished themselves from other healers by banding together to form professional associations dedicated to science-based practice. \u00a0Even more important, medical ethics put the patient first, above considerations of personal gain or even collective social goods. \u00a0The medical guild may have been insular, self-protectively territorial and paternalistic, but it was also self-sacrificing and altruistic. \u00a0Doctors earned the public’s trust one patient, or family, at a time.<\/p>\n

The last quarter of the 20th Century saw this guild wither\u00a0under waves of commercialism and populism. \u00a0Third party payers started\u00a0“managing” care, trumping\u00a0medical decisions with budgetary ones. \u00a0Large medical corporations leveraged economies of scale to provide services at lower cost. \u00a0Meanwhile, government oversight gradually replaced the guild’s self-policing. \u00a0Since the days of Vietnam and Watergate, no authority in America, even medicine, gets a\u00a0free pass. \u00a0With oversight comes infrastructure, formalized quality control, reporting requirements. \u00a0Unfortunately, sensible-sounding social policy\u00a0may be unworkable\u00a0on the ground. \u00a0Private medical practices are gradually\u00a0disappearing<\/a>.<\/p>\n

The weakening grip of physicians over the practice of medicine re-opened the door for commercial innovation \u2014 or pandering, depending on one’s perspective. \u00a0Generations ago, patients were drawn to inexpensive folk remedies, expensive patent medicines, and traveling road shows. \u00a0The modern parallels are free information on the internet, ads for expensive prescription drugs on television, and slick\u00a0smartphone apps. \u00a0Patients now\u00a0see a doctor for a one-time encounter\u00a0online,\u00a0at\u00a0an urgent care clinic, or in a “Minute Clinic<\/a>” behind\u00a0a chain drugstore. \u00a0Enhanced access and convenience, often at lower cost, is the upside. \u00a0The downside is fragmentation of medical care rendering\u00a0it an\u00a0impersonal commodity, where doctors are interchangeable and patients are widgets on an assembly\u00a0line.<\/p>\n

The hard lesson\u00a0of the marketplace is\u00a0caveat emptor<\/em>. \u00a0Little wonder that patients only\u00a0reluctantly divulge personal matters to strangers in\u00a0white coats, and increasingly prefer to do their own online research. \u00a0A trusting doctor-patient relationship, once the soul of medicine, begins\u00a0to sound\u00a0as quaint and precious as “old world craftsmanship” \u2014 nice if you can afford a\u00a0concierge doctor who\u00a0still offers it.<\/p>\n

A number of\u00a0battles are being waged in this\u00a0larger\u00a0war between professionalism and commercialism. \u00a0On one side are physicians rallying under\u00a0the traditional banner\u00a0of uncompromising standards, and prizing\u00a0the individual patient over cost and social considerations. \u00a0Detractors, however, paint this stance as paternalistic, and say doctors are clinging\u00a0to the last scraps of guild status and privilege. \u00a0On the other\u00a0side are\u00a0entrepreneurs happy to “disrupt” the status quo and give the public what it wants, namely lower cost, faster service, and transparency. \u00a0Detractors, however, say these entrepreneurs pander to a fast-food mindset\u00a0that cuts corners and increases\u00a0medical risk.<\/p>\n

The\u00a0Texas Medical Board ruled\u00a0earlier this year that doctors must examine patients in person (or “face to face”) before treating\u00a0them online, essentially declaring telemedicine an adjunct to in-person care, not a replacement. \u00a0Teladoc, the largest U.S. telemedicine provider, filed an antitrust lawsuit in U.S. District Court, which\u00a0suspended<\/a>\u00a0the Board’s ruling. \u00a0The court’s\u00a0decision\u00a0suggests it is not up to doctors to set a standard of medical care. \u00a0It’s a marketplace decision. \u00a0If people want to be diagnosed without the benefit of a physical examination, and companies choose\u00a0to provide that service, that’s their right. \u00a0It will be interesting to see\u00a0whether\u00a0medical malpractice will be harder to prove\u00a0once\u00a0the marketplace lowers\u00a0the standard of care.<\/p>\n

Likewise, doctors favor<\/a>\u00a0follow-up visits to discuss certain test results, particularly those with life or death implications. \u00a0 This is motivated by benign paternalism: putting the results in context, softening the blow of bad news, helping the patient not jump to conclusions, framing the next steps. \u00a0Many service professionals, from caterers to auto mechanics, offer\u00a0at least a little of this contextualization. \u00a0But it’s a value-added service that costs real money in medical practice. \u00a0Many patients prefer\u00a0to get their results online or directly from the lab instead: it’s faster, less expensive, and feels more transparent. \u00a0Interpreting the results with the help of\u00a0Dr. Google\u00a0is a risk that saves time and money.<\/p>\n

The tension between traditional medical values and expanding commercialism, amplified in this age of instant online information and services, puts the squeeze on physicians. We need to explain our rationales carefully and stand up for high quality in the face of expediency. \u00a0Yet we also need to choose our battles. We may be forced\u00a0to accept a role\u00a0for\u00a0medical fast food as well as fine dining. \u00a0And this is not only for the sake\u00a0of affordability, although that’s one very real consideration. \u00a0Americans crave speed and convenience,\u00a0as distasteful as that may be to old-world craftspeople, Cordon\u00a0Bleu\u00a0chefs, and principled physicians. \u00a0Speed, cost, quality \u2014 pick any two.<\/p>\n","protected":false},"excerpt":{"rendered":"

The history of American medicine is the story of the rise and fall of a professional guild. In the 19th and early 20th Centuries, physicians distinguished themselves from other healers by banding together to form professional associations dedicated to science-based practice. Even more important, medical ethics put the patient first, above considerations of personal gain […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[67],"tags":[69,48,13,36],"class_list":["post-1063","post","type-post","status-publish","format-standard","hentry","category-medical-practice","tag-commericalism-in-medicine","tag-commodity","tag-ethics","tag-risk","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1063","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1063"}],"version-history":[{"count":7,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1063\/revisions"}],"predecessor-version":[{"id":1074,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1063\/revisions\/1074"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1063"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1063"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1063"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}