Caught up in the Middle – Physician in Politics

I was recently speaking with a friend of mine who had been engaged in a conversation with an Uber driver. Their brief conversation was about healthcare and the many factors that contribute to the “complicated” environment; but their focus shifted to the patient/doctor relationship.

Some time ago, I was made aware of an interesting article where a couple of physicians referred to an economist who suggested that public policy “is grounded in a conception of humans as knights, knaves or pawns.”

I got to thinking about all my friends who are in fact medical professionals and all of the healthcare facilities that I have so enjoyed working. Could these physicians vis-a-vie the British economist comment basically be asking are we motivated by our financial successes, by the noble profession of aiding the sick or is perchance collateral damage or consequence of governmental gamesmanship?

I suppose the image of the knight as the caregiver carries a heavy burden. As it applies to my life and those that surround me, my knight “in shining lab coat” carries with it my best interests. I am certain that whatever medical decisions are made with the coat of arms that says first do no harm. From there on end, my decisions alongside the suggestions of all my caregivers will be made based on what the malady is at hand. In days gone by, I now trust Telemedicine consultations instead of the all too common physical visits for a few of my minor ailments. I have to say it’s a long cry from when providers used to come to your house at a cost no more higher than visiting them in their offices.

But times have changed and income origin and sustainability has changed. Insurance carriers have been inserting themselves into the conversation of dictating care. There are many “what, why, and hows” in the equation for the provider to answer along with the patient.

  • What is covered?
  • What is worth, to the insurance carrier?
  • What is worth, to the patient?
  • Why is it medically necessary in the first place?
  • How did it get to this point?
  • Etc.

So now the Knight has key elements to creating an action based on financial circumstances. This knight must also manage the administration of these circumstances. Work and play are forces that are often at odd with each other now. Splash heavier work loads, complex case management and developing technology in the advancement of medicines and our knight has much more to consider.

As for the knave, humankind has always had those who are dishonest. No doubt those paying hefty fines for administering medically unnecessary procedures, over-billing in all aspects and other examples of taking advantage of a system that had limited oversight in the reimbursement processes. These attribute to the tighter controls that we see come out each year from HHS, CMS and the commercial medical insurance industry. The knaves made it both hard to rip off an institution and for those who are not doing harm, to reward them for good outcomes. I get it, costs were rising; a few bad apples really made it harder for the knight who is just trying to do well by the patient.

But as costs of care have risen, as more safety lapses have been recognized, as quality has not been kept up with enhanced knowledge, the public has come to believe that the physician is the problem and not the solution.

The pawn (patient) and the physician are caught up in the realm of public policy making, both are suffering the consequence from influences completely out of their control. The physician, attempting to do the right thing may be under the influence of the financial success. Public policy is being shaped by those in leadership that by and large have no real practical experience in caring for the sick, or have they been touched by the tragedies of illness? Nonetheless, here we are navigating healthcare via governmental public policy. Who receives medical attention for episodic and continuous care is at stake, with pawns left to figure it all out.