The Covert Rationing Blog

Why the Doctor-Patient Relationship Has To Go

July 30th, 2007 by DrRich

Consider the problem faced by the CEO of an HMO, or a Medicare administrator, or any one of the other individuals we have deputized to reduce our healthcare costs.

When such an individual looks out over the landscape of medicine as it is traditionally practiced, he beholds a frightening sight: over two million times each day, individual physicians and individual patients - just the two of them, alone in a room - make millions of individual decisions about which healthcare resources should be called upon for the sake of that individual patient at that particular time. And when each of these decisions is finally reached, and the doctor places pen to paper and signs her name, the entire medical-industrial complex immediately bends to her will.

Our CEO, witnessing all this in a cold sweat, is thinking, “They’re spending my money.”

Actually, they’re spending society’s money. But whoever has dibs on the money, the fact remains that we can no longer allow such spending decisions to be made in a vacuum, as if the cumulative effect of those decisions on society are irrelevant. Since we cannot affect those individual spending decisions through an open system of rules - since that would be admitting that we are rationing - we must affect them in some other way.

To both the HMO executive and the governmental regulator, the answer is quite simple. Coercive pressure must be applied at the focal point of all healthcare spending - the physician-patient encounter - to force spending decisions to be made on the basis of something other than what is best for the patient.

Covert rationing requires that decisions made at the bedside be made with society’s priorities in mind, and not the patient’s. Indeed, covert rationing demands that the doctor forgo his primary duty to his patient, in favor of “the greater good.” The demand is non-negotiable. If doctors are reluctant to give up their traditional role as their patients’ advocates, they must be coerced into doing so, and the ones who still refuse need to be weeded out. Thus, an essential truth is revealed. The engine that drives covert rationing must be - can only be - disruption of the doctor-patient relationship. So the traditional doctor-patient relationship has been specifically targeted for destruction by both the Gekkonians and the Wonkonians.

There is no denying that the needs of society are important. In fact, if the proportion of the gross national product we spend on healthcare is not soon limited, we will find our society becoming dangerously unstable. But by choosing to limit our health care spending surreptitiously, by rationing at the bedside, by making our physicians the agents of rationing instead of the agents of their patients, we choose a particularly deadly approach to this problem.

Doctors, as imperfect as they are, are the only thing standing between patients and the growing lust for cost-cutting displayed by HMOs, insurers, hospitals, the government, and the majority of citizens who are not seriously ill at any given time. When we permit the destruction of the traditional doctor-patient relationship, not only do we abandon patients to their own devices in this hostile environment, we do so in their very hour of need, and at the very time they are least capable of fending for themselves. The doctors, too, are grievously wounded by the loss of this relationship. For when doctors turn away from their obligations to their patients, even if only because they are coerced, they betray the first principle of medical practice and devalue their profession to the point of worthlessness.

But when compared to the need to keep the rationing covert, both the right of the sick patient to an advocate and the integrity of the medical profession have been reduced to “nice to haves.” Worse, they have been reduced to “must goes.”

Posted in General Rationing Issues

4 Responses to “Why the Doctor-Patient Relationship Has To Go”

1. The Covert Rationing Blog » Blog Archive » The AMA Takes on In-Store Health Clinics wrote on 09/21/07 at 7:19 am :

   […] sacred doctor-patient relationship seems a bit sad, given that doctors themselves already have been systematically forced into abandoning that relationship. (If patients can’t have a doctor-patient relationship anymore, one wants to ask, can’t […]

2. The Covert Rationing Blog » Blog Archive » A Unique Way to Salvage the Doctor-Patient Relationship wrote on 10/31/07 at 11:17 am :

   […] we have seen, covert healthcare rationing requires destruction of the classic doctor-patient relationship (since a common final pathway for covert rationing is the bedside). The government and private […]

3. The Covert Rationing Blog » Blog Archive » Patients, Doctors, and Remote Third Parties wrote on 12/22/07 at 10:37 am :

   […] as we have seen, severing the classic doctor-patient relationship is Job One under a system of covert rationing. […]

4. epistemocrat wrote on 01/8/08 at 2:59 am :

   Great essay. The doctor-patient relationship is the foundation of a successful health system; I still cannot understand how poorly we comprehend this reality. I have recently blogged about the need to restore and empower the doctor-patient relationship: epistemocrat.blogspot.com

   Keep up the great work DrRich!

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