You paint a powerful picture of relatively simple, common sense solutions which are left to the wayside because they don't rank highly under corporate priorities. Is this being caused by a hodge podge of factors, or is there a central controlling function such as a state medical board that should ought to be, but is not, tending to the most important role of getting people better?
Thanks for the thoughtful question. My apologies for not replying sooner, but I literally wanted to sleep on the two thoughtful and complex issues you raise: the hodgepodge of factors controlling medicine and whether state medical boards play a role in this hodgepodge.
The hodgepodge of government and big business organizations interfering with physician decisions about their patients’ healthcare is a tremendous problem. We know that the Centers for Medicare and Medicaid Services (CMS) spends millions of dollars on studies of the problem of fragmentation of services, but I believe some of those studying the problem really aren’t able to see what’s happening. I also believe there are many people who do understand how our healthcare has become so fragmented but don’t want to fix the problem.
I’m old enough to actually have watched Johnny Carson interview Gloria Steinem. She was explaining the evolution of her wisdom and strength as a journalist and feminist. She said when she was young and naïve, she thought she could get help problem solving by going to the boss, but she eventually discovered that the boss WAS the problem.
And, so it is today, many bosses are at the heart of the problem. We have our hodgepodge of entities, including CMS, many large healthcare insurers, large pharmaceutical companies, the electronic medical record companies, and arrogant & devious CEOs who promote themselves as healthcare leaders.
You also raise the question of the role of state medical boards in creating this fragmentation of healthcare. States grant medical boards a large amount of power supposedly for the purpose of preventing harm to patients. Their power is so extreme that even the supreme courts of the states seldom interfere with med board activities. In North Dakota, the state Supreme Court told a physician they had no authority over the state medical board. The physician would have to take his issue to the state legislature. I have always maintained that a state should provide a direct and public oversight of any entity it creates.
Another problem with medical boards is that they are governed by administrative law, so they don’t fall under the protection of civil or criminal due process. State legislators grant medical boards omnipotence, but allow each board to define their own level of due process, which may be considerably different from state to state. Since medical boards operate in secret (somehow supposed to benefit the public), they can perform their actions however they see fit. Any agreement with a medical board contains hand waving in the direction of due process, but there is no way to legally hold medical boards liable for due process. In my experience, medical boards overlook real harm to patients and punish imaginary harm severely. But despite these problems with state medical boards, they are not directly involved in the fragmentation of medical care beyond removing good physicians from practice and leaving the physician’s hundred of patients without a physician.
As I’ve already said, the good news is that the solutions are simple. The bad news is that we’re going to spend millions of dollars and years if not decades studying the problem. Studying is a sidestep to replace actually solving the problem, which most high-power entities really don't want to solve, because a real solution would mean more affordable care for the public, and greater patient access to care, but far less money for the power mongering entities. Alan L
Thank you for taking the time to write such a thoughtful response Doc. It's a shame that so many of the issues getting in the way of patient-oriented outcomes are an issue of power and not love. Power over, not power for the sake of, patient outcomes. Self-love, not love for the populace. Seems kinda like something got writ backwards at some point.
I've done some reading about Flexner and all the things that followed, and it's hard not to conclude that there is a great deal of both neglect and purposeful energy going into bottom lines at the cost of patients. It would be a gift if we were all pulling together, and health care was not more and more an industry with profit centers but rather than a field of care with compassion and proficiency centers. I do appreciate efforts to create a parallel network of true health care; may the Gods and Goddesses align with that good work.
You paint a powerful picture of relatively simple, common sense solutions which are left to the wayside because they don't rank highly under corporate priorities. Is this being caused by a hodge podge of factors, or is there a central controlling function such as a state medical board that should ought to be, but is not, tending to the most important role of getting people better?
Thanks for the thoughtful question. My apologies for not replying sooner, but I literally wanted to sleep on the two thoughtful and complex issues you raise: the hodgepodge of factors controlling medicine and whether state medical boards play a role in this hodgepodge.
The hodgepodge of government and big business organizations interfering with physician decisions about their patients’ healthcare is a tremendous problem. We know that the Centers for Medicare and Medicaid Services (CMS) spends millions of dollars on studies of the problem of fragmentation of services, but I believe some of those studying the problem really aren’t able to see what’s happening. I also believe there are many people who do understand how our healthcare has become so fragmented but don’t want to fix the problem.
I’m old enough to actually have watched Johnny Carson interview Gloria Steinem. She was explaining the evolution of her wisdom and strength as a journalist and feminist. She said when she was young and naïve, she thought she could get help problem solving by going to the boss, but she eventually discovered that the boss WAS the problem.
And, so it is today, many bosses are at the heart of the problem. We have our hodgepodge of entities, including CMS, many large healthcare insurers, large pharmaceutical companies, the electronic medical record companies, and arrogant & devious CEOs who promote themselves as healthcare leaders.
You also raise the question of the role of state medical boards in creating this fragmentation of healthcare. States grant medical boards a large amount of power supposedly for the purpose of preventing harm to patients. Their power is so extreme that even the supreme courts of the states seldom interfere with med board activities. In North Dakota, the state Supreme Court told a physician they had no authority over the state medical board. The physician would have to take his issue to the state legislature. I have always maintained that a state should provide a direct and public oversight of any entity it creates.
Another problem with medical boards is that they are governed by administrative law, so they don’t fall under the protection of civil or criminal due process. State legislators grant medical boards omnipotence, but allow each board to define their own level of due process, which may be considerably different from state to state. Since medical boards operate in secret (somehow supposed to benefit the public), they can perform their actions however they see fit. Any agreement with a medical board contains hand waving in the direction of due process, but there is no way to legally hold medical boards liable for due process. In my experience, medical boards overlook real harm to patients and punish imaginary harm severely. But despite these problems with state medical boards, they are not directly involved in the fragmentation of medical care beyond removing good physicians from practice and leaving the physician’s hundred of patients without a physician.
As I’ve already said, the good news is that the solutions are simple. The bad news is that we’re going to spend millions of dollars and years if not decades studying the problem. Studying is a sidestep to replace actually solving the problem, which most high-power entities really don't want to solve, because a real solution would mean more affordable care for the public, and greater patient access to care, but far less money for the power mongering entities. Alan L
Thank you for taking the time to write such a thoughtful response Doc. It's a shame that so many of the issues getting in the way of patient-oriented outcomes are an issue of power and not love. Power over, not power for the sake of, patient outcomes. Self-love, not love for the populace. Seems kinda like something got writ backwards at some point.
I've done some reading about Flexner and all the things that followed, and it's hard not to conclude that there is a great deal of both neglect and purposeful energy going into bottom lines at the cost of patients. It would be a gift if we were all pulling together, and health care was not more and more an industry with profit centers but rather than a field of care with compassion and proficiency centers. I do appreciate efforts to create a parallel network of true health care; may the Gods and Goddesses align with that good work.