Two doctors from Beth Israel Deaconess Medical Center, Harvard's teaching hospital, have taken an unusual step for the medical profession. These courageous physicians are speaking out about today's healthcare system which
emphasizes money over individualized patient care.
In an article just published in The New England Journal of Medicine, Pamela Hartzband, MD, and Jerome Groopman,MD, are blunt about their frustration with a system that has "reduced medicine to economics." In fact, they go so far as to say hospitals have been turned into "factories" that reduce clinical encounters between a patient and doctor into simply "economic transactions."
"Patients are no longer patients, but rather customers or consumers. Doctors and nurses have transmuted into providers," Pamela Hartzband, MD, and Jerome Groopman MD, wrote. "We are in the midst of an economic crisis and efforts to reform the health care system have centered on controlling spiraling costs. To that end, many economists and policy makers have proposed that patient care should be industrialized and standardized. Hospitals and clinics should be run like modern factories and archaic terms like doctor, nurse and patient must therefore be replaced with terminology that fits this new order."
One of the problems, according to Dr. Hartzband and Dr. Groopman, is that the knowledge physicians and nurses have and should be able to use to help patients individually is getting lost. Instead, the current "factory" system of medicine values prepackaged, off-the-shelf solutions that substitute "evidence-based practice" for "clinical judgment." Simply put, healthcare providers are no longer expected to spend time carefully considering patients as individuals and using their experience to make the best decisions for specific people and their health problems. Instead, doctors and nurses are supposed to offer a cookie cutter approach that moves patients through the system quickly as though they were things to be processed on a conveyor belt, not complex human beings to be treated as individuals.
"Reducing medicine to economics makes a mockery of the bond between the healer and the sick," the doctors wrote in their article. "For centuries doctors who were mercenary were publicly castigated. Such doctors betrayed their calling. Should we now be celebrating the doctor whose practice, like a successful business, maximizes profits from customers?"
Individualized care has been replaced by a factory-like business
Dr. Hartzband and Dr. Groopman pointed out the new emphasis on "evidence-based practice" is not really a new concept because evidence was routinely presented during daily rounds or clinical conferences where doctors debated numerous research findings in the past.
"But the exercise of clinical judgment, which permitted the assessment of data and the application of study results to an individual patient, was seen as the acme of professional practice," they emphasized in their paper. "Now some prominent health policy planners and even physicians contend that clinical care should essentially be a matter of following operating manuals containing preset guidelines, like factory blueprints, written by experts."
In a media statement, the Beth Israel Deaconess Medical Center physicians noted that working with the same data, different groups of experts often come up with totally different guidelines for conditions as common as hypertension and elevated cholesterol levels or for the use of screening tests for prostate and breast cancer. "The specific cutoffs for treatment or no treatment, all necessarily reflect the preferences of experts who write the recommendations. And these preferences are subjective, not scientific," they concluded. The doctors are also upset about the new politically correct ways to describe patients and physicians -- and how this new vocabulary is impacting healthcare in the U.S. "Recasting their roles of doctors and nurses, as providers who merely implement prefabricated practices diminishes their professionalism. Reconfiguring medicine in economic and industrial terms is unlikely to attract creative and independent thinkers with not only expertise in science and biology but also an authentic focus on humanism and caring," Dr. Hartzband and Dr. Groopman stated.
"When we ourselves are ill, we want someone to care about us as people, not paying customers. We want to be treated as individualize and we want our treatment according to our values. Despite the lip service paid to patient-centered care, by the forces promulgating the new language of medicine, their discourse shifts the focus from the good of the individual to the system and its costs," they added. "We believe doctors, nurses and others engaged in care should eschew the use of such terms that demean patients and professionals alike and dangerously neglect the essence of medicine."
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