Sunday, January 11, 2015


I came across an article in the New England Journal of Medicine recently and it provoked some thoughts that I would like to share with you.
But before we go to my thoughts let us reflect on these two paragraphs:

“Research suggests that for physicians to play a substantial role in such decision making, there has to be a relatively high level of public trust in the profession's views and leadership. But an examination of U.S. public-opinion data over time and of recent comparative data on public trust in physicians as a group in 29 industrialized countries raises a note of caution about physicians' potential role and influence with the U.S. public.”


“Indeed, the United States is unique among the surveyed countries in that it ranks near the bottom in the public's trust in the country's physicians but near the top in patients' satisfaction with their own medical treatment.”

The Authors then opine and in the same breath contradict themselves:

“Part of the difference may be related to the lack of a universal health care system in the United States. However, the countries near the top of the international trust rankings and those near the bottom have varied coverage systems, so the absence of a universal system seems unlikely to be the dominant factor.”

They go on to segment the population to achieve a meaningful use of their article:

“The United States also differs from most other countries in that U.S. adults from low-income families (defined as families with incomes in the lowest third in each country, which meant having an annual income of less than $30,000 in the United States) are significantly less trusting of physicians and less satisfied with their own medical care than adults not from low-income families“

And then from the double-speak right from the Animal Farm:

“Although non–low-income Americans expressed greater trust in physicians than their low-income counterparts did, when responses were analyzed by income group, the United States still ranked 22nd in trust among the 29 countries. On the flip side, although low-income Americans were less likely than non–low-income Americans to report being completely or very satisfied with their own care, the United States still ranked seventh in satisfaction among low-income adults (ISSP 2011–2013).”

They do grasp the problem meekly:

“We believe that the U.S. political process, with its extensive media coverage, tends to make physician advocacy seem more contentious than it seems in many other countries.”

But then squirt it away with this politically-motivated, correctly-interfaced, seemingly-validated, interlaced through the arbiter of political correctness against the physicians’ diatribe:

“Nevertheless, because the United States is such an outlier, with high patient satisfaction and low overall trust, we believe that the American public's trust in physicians as a group can be increased if the medical profession and its leaders deliberately take visible stands favoring policies that would improve the nation's health and health care, even if doing so might be disadvantageous to some physicians.”

And as always they warn with icy-cold fangs that draw blood and impose fear and humiliation among the physicians with:

“If the medical profession and its leaders cannot raise the level of public trust, they're likely to find that many policy decisions affecting patient care will be made by others, without consideration of their perspective.”

Let us ask these authors the very basic question, "Who are you?" And you find that there is not a single physician among them and not even one that has moved to the dark side of regulatory capture. The degrees they hold; a Sc.D, an M.A., and an M.P.H. The last one of course has the associative epidemiological know how to prove that association is tantamount to causation.

Unfortunately NEJM is complicit in this fine act of political correctness by endorsing such nonsense.

Why for heaven’s sake, can patients be happy with their physician but angry overall? Because the media and the political machinery is constantly yammering away at the costs of healthcare and that physicians are the root cause of that cost. It is 17.9% of the GDP they bellicose, but they never seem to deem it necessary that majority of that is the middling administrative management that derives oodles and oodles of money. If one were to simply seek an answer, one has to look at the 2012 Data Dump by Medicare, which showed that only $77 Billion was in direct payment to the doctors from the $985 Billion expensed and that translates loosely to about 7.78%. Of that, a large part was a direct pass-through for fixed costs, medication and equipment. But no, that would not fit the Elite narrative. No, that absolutely won’t do!

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