Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Diagnosis: malformation of a health care system

Jeffrey Fraser, MD
Policy
July 17, 2021
131 Shares
Share
Tweet
Share

In recent years, we have seen a magnificent increase in the accuracy of medical diagnoses. As the most compelling example, l propose the diagnosis provided by our country’s top clinicians with regard to what ails our health care system. Seasoned veterans of outpatient clinics, emergency rooms, intensive care units, hospital wards, and operating suites, they have focused their finely honed diagnostic acumen on themselves, their colleagues, and the system in which they practice. In this context, the dictum, “physician, heal thyself,” was never more profound. They have published their authoritative evaluations and recommendations for all to read.

In Mistreated: Why We Think We’re Getting Good Health Care—and Why We’re Usually Wrong, Dr. Robert Pearl, former CEO of The Permanente Medical Group and member of the faculties at the Stanford medical and business schools, draws upon his personal experiences and an array of highly pertinent scientific findings to expose the many serious flaws in the way we deliver health care to our citizens. In Uncaring: How the Culture of Medicine Kills Doctors and Patients, this perspicacious plastic surgeon explains how physicians’ intrinsically large reservoir of empathy is systematically drained by a culture that has lost sight of the critical importance of this one most valuable attribute.

In Broken, Bankrupt, and Dying: How to Solve the Great American Health Care Ripoff, Dr. Brad Spellberg, chief medical officer at the Los Angeles County-University of Southern California Medical Center, lays out the economics of health care in terms anyone can understand while seasoning his narrative with poignant vignettes culled from years of caring for the underprivileged. His assessment is unassailable: compared to citizens of other developed countries, Americans are getting fleeced by the profiteers of the medical-industrial complex.

In Doctored: The Disillusionment of an American Physician, Dr. Sandeep Jauhar, a cardiologist, explains how the fundamental cause of physician burnout is simply the realization that one is working in a broken, unjust, and impersonal system.

Like Dr. Jauhar, I have suffered the symptoms of burnout. Like Dr. Spellberg, I have worked in a large public hospital in California. During my almost 30 years of practicing neurology at Santa Clara Valley Medical Center, in the heart of Silicon Valley and just 20 minutes down the freeway from Stanford, I too have witnessed tragic and maddening consequences of losing one’s health insurance when it is most needed, or having inadequate access to proper preventative health care until an emergency arises. Like Dr. Pearl, I have seen what happens when doctors, despite being motivated by a desire to help, cause harm by falling under the spell of false hopes, promoted by a medical-industrial complex intent on maximizing profits, and eagerly embraced by an ingenuous public.

An ideal health care system would feature a resolute commitment to these three fundamental virtues: compassionate uninterrupted care for all, rigorous scientific standards, and cost-effectiveness. The cruel arbitrariness of a world where health care coverage for oneself and one’s family is subject to the vagaries of one’s employment status is incompatible with the first virtue. A fee-for-service payment model, embedded within a profit-seeking medical-industrial complex, is incompatible with the second and third virtues. Imagine a system comprising only non-profit health care organizations that employ a capitated payment (global budget) model, contracting with the government to serve all citizens at all times, regardless of their employment or health status.

As a prototype of the sort of health care delivery network found in an ideal national health care system, let me propose Kaiser Permanente, a highly successful non-profit health care organization operating 39 hospitals and over 700 medical offices in eight states and employing over 80,000 doctors and nurses. Kaiser Permanente’s capitation payment model allows it to put cost-effective, evidence-based medical care front and center as its highest priority. Among the many fruits borne from this model is an alignment of incentives to optimize the use of telemedicine, information technology, and an integrated electronic medical record, allowing Kaiser, in this regard, to leave its fee-for-service competitors in the dust.

The U.S. government, contracting with a number of Kaiser-like entities, competing with each other to provide the best care in the most efficient manner, while sharing best practices, would vault the American health care system to first place among developed countries, from its current position as an also-ran. Moreover, in the absence of such a transformation, American health care is destined to fall farther and farther behind countries that have adopted, or are in the process of adopting, an integrated, evidence-based health care system with universal coverage. The resistance to transformation is formidable, and therefore change must be led from within. Success depends on physician leaders convincing their colleagues and their patients that the path to wellness requires an elixir that, for many, has a bitter taste and is sometimes painful to swallow.

The diagnosis is well-established. A cure is within our reach, and the wisest among our practitioners of the healing arts are offering valuable counsel. When the U.S. government and science, in its most principled form, work together, insulated from a culture of insidious and invidious profiteering, they can put a man on the moon, and launch a helicopter on Mars. They can also deliver better health care in a much more equitable and cost-effective way. It is time for the patient to listen to her best doctors. They are giving it to her straight.

Jeffrey Fraser is a neurologist.

Image credit: Shutterstock.com 

Prev

A physician shares images of humanity

July 17, 2021 Kevin 0
…
Next

4 lessons the pandemic has taught health care

July 17, 2021 Kevin 0
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
A physician shares images of humanity
Next Post >
4 lessons the pandemic has taught health care

More by Jeffrey Fraser, MD

  • The blueprint for a Gold Medal Health Care System

    Jeffrey Fraser, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why health care replaced physician care

    Michael Weiss, MD
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • Health care workers should not be targets

    Lori E. Johnson

More in Policy

  • Unveiling the intricate link between housing costs and health care

    Harvey Castro, MD, MBA
  • Uncovering the truth about racial health inequities in America: a book review

    John Paul Mikhaiel, MD
  • Why affirmative action is crucial for health equity and social justice in medicine

    Katrina Gipson, MD, MPH
  • The untold story of Hispanic/Latino health: Why subgroup data matters

    Matthew B. Alonso
  • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

    Osmund Agbo, MD
  • Family physicians unite at the U.S. Capitol, seeking congressional support for Medicare reform and health care transformation

    Tochi Iroku-Malize, MD, MPH, MBA, Sterling N. Ransone, Jr., MD, and Steven P. Furr, MD
  • Most Popular

  • Past Week

    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • The controversial oaths of American doctors: Prioritizing ethics over patients?

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician
    • From skydiving to saving lives: a surgeon’s journey on adversity, passion, and perseverance [PODCAST]

      The Podcast by KevinMD | Podcast
    • How can there be joy in medicine if there is no joy in Mudville?

      Arthur Lazarus, MD, MBA | Physician
    • Unveiling the intricate link between housing costs and health care

      Harvey Castro, MD, MBA | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • 'Medically Relevant to Saving the Life of Your Patient': What We Heard This Week
  • Want to Solve the Nurse Shortage?
  • Why Are Female Doctors Sued Far Less Often Than Male Doctors?
  • What Drug Did FDA Just Approve for COVID?
  • PET Scan for Alzheimer's Dx; Predicting Colon Cancer Survival

Meeting Coverage

  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Trial Results Spark Talk of Curing More Metastatic Cervical Cancers
  • Cross-Border Collaboration Improves Survival in Pediatric Leukemia Patients
  • Monoclonal Antibody Reduced Need For Transfusions in Low-Risk MDS
  • Less-Invasive Surgery for Pancreatic Cancer Proves Safe, Effective
  • Most Popular

  • Past Week

    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • The controversial oaths of American doctors: Prioritizing ethics over patients?

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician
    • From skydiving to saving lives: a surgeon’s journey on adversity, passion, and perseverance [PODCAST]

      The Podcast by KevinMD | Podcast
    • How can there be joy in medicine if there is no joy in Mudville?

      Arthur Lazarus, MD, MBA | Physician
    • Unveiling the intricate link between housing costs and health care

      Harvey Castro, MD, MBA | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...