Empowered patients need to ask themselves a basic question

I have nothing against the patient empowerment movement.  In fact, I think an informed and collaborative partnership is mutually beneficial.  But I can’t help but laugh when I read some of these tweets.

Death to paternalistic medicine!

The age of paternalistic medicine is over!

True, the era of doctor knows best is long gone.  But it’s a mistake to think think today’s health care consumer has any more leverage than before.  It just seems that way.  The reason is that the strings are being pulled, and the levers are being switched in a slightly more diabolical way.

If you want to know the root of any modern problem, either follow the money or follow the power.  You think you have control over your health care decisions, but in reality, many are being made for you before you even step foot in the office.  You see, your options are being whittled long before the exam room door is breached.

Want to spend thirty minutes talking about end of life care?  Good luck.  The government has deemed that doctors shouldn’t get paid for such conversations.  Guess who will try to avoid them at all costs?

Want a PSA test?  Well the USPSTF has deemed that they are not beneficial (which I agree with by the way), and eventually Medicare and private insurance will refuse to pay for them.  Most physicians will avoid offering such tests if they are going to be dinged on quality and cost efficiency metrics.

You just had a heart attack and your cardiologist thinks you need a defibrillator.  Not so quick.  You’ll be offered a defibrillating vest first until you wait a certain number of months, unless your doctor wants to get investigated by the Department of Justice.

It’s not that I don’t agree with some of these decisions.  Some make sense.  But don’t think you have power to control your own destiny.  What once was the purview of your trained doctor has fallen to an array of nonclinical and barely clinical administrators in Medicare and private insurance.

So empowered patients of the world might just want to ask themselves a basic question.

Who’s your Daddy now?

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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