Thursday, May 22, 2014


"The Space Between
The wicked lies we tell
And hope to keep safe from the pain"
 ~Dave Matthews Band

In medicine the contract used to be between the physician and patient. If the patient had a disease X and went to a doctor to get relief from it. The doctor would prescribe a procedure/medication/encouragement Y, the contract was fulfilled when the transaction was completed. Those were simpler times.

Today the space between the physician and the patient is littered with intermediaries. The straight-line of care between the physician and patient has been disrupted. Everyone is an expert trying to angle into the game. This angling increases the gulf between the two parties. The current dictates cover what the physician can or cannot do and what the patient can or cannot receive in terms of care and what the government/insurer  will or will not pay for those services to the physician.

The Complexity of interactions within the Healthcare System of Medical Care
(If unable to view clearly please ask and I will send you a larger .pdf file)

A legion of experts devotes an inordinate amount of time to make itself known and considered useful in maintaining its place as arbiters of such a contract and to fill the space in between. These experts exact a price from the heath-care system and cast aspersions if necessary, on the physicians and when able through tongue and cheek at the patients as well. The emotional contract between the two parties has been reduced to a binary value for the experts to claim the defect in the care rendered using a set of arbitrary and capricious probability assumptions.

The market forces of supply and demand work admirably in business and they also work equally well in health care settings, if allowed. A competent doctor is rewarded with patients seeking his or her help. Yet in today’s climate the patient seeks out those doctors that accept insurance. This sets up a “mill” or an assembly-line of sorts and quality is sacrificed for quantity.  Time is at a premium and eye to eye contact is marginalized. Enter the EMR system, which further alienates. The real understanding of the disease stems not from the cut, copy and pasted 14-paged document for insurance reimbursement but in the single expression of the malady in a patient’s face.  

The multitude of forces that compete within the sphere of the patient physician relationship are increasing daily and advancing their cause to the detriment of the patient-care. Something needs to be done. Something will have to give!

The current zeitgeist circulating the society and reinforced by the governmental and insurance industry is that medical care is a right. Is it? Healthcare costs sky rocket because of overuse of the system. Maybe it is time to reinvent the paradigm of developing the concept of “skin in the game,” and not of, it is ours for free, go get a prescription. Maybe it is time for some hard lessons and education. Maybe it is about lifestyles against chronic illnesses.  Maybe it is about understanding after all.

Dave Matthews Band...Enjoy!

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