Physician Collegiality

Over the past year, retired physician, Ted Bacharach, has written several posts to Authentic Medicine about the loss of one of the very professional attributes of physicians, collegiality. I was hoping to see some responses to his post.  There were none.

On the surface, this may look like misplaced nostalgic longing for some antiquated old fraternity buddiness, but it was far more than that. It wasn’t a football game rah-rah-zizz-boom-bah.  It was professional respect for fellow physicians.

When the media reminisces about the Marcus Welby kind of patient care, the focus is usually on the one-on-one relationship between the doctor and the patient, the intrusion of insurances into the doctor patient relationship, or the failure of managed care organizations. David Dranove in From Marcus Welby to Managed Care, and more recently, Dr. Lowell Fisher in Marcus Welby is Dead.

One of the missing parts of the picture which never quite makes it into priint is loss of physician collegiality.

So what’s that, you say?

When physicians agreed to turn over the decisionmaking about their patients to Medicare, insurance companies, and medical corporations run by non-physicians, it became dangerous for physicians to support one another within an organization, and it became dangerous to be independent. The physician was a “company” person and was supposed to support the corporate policy on saving money or denying care.

Managed care has never delivered on it’s promise to reduce health care costs except initially because the persons making the decisions about patient care aren’t physicians, but managers interested in making the company look profitable.

Corporate medicine operates the same way.  Physicians who work for large medical organizations are supposed to tow the company line.  In reality, towing that line more often than not means denying patient care the physician may well know is self-defeating, and sometimes downright deadly.

The media allusion is that physicians can’t make medical decisions without an overseer because they will always order more than the patient needs to pad the bill.  This is a vicious misrepresentation of the majority of physicians practice.  It’s no different than the media hype about some hugely fraudulent Medicare bust.  The public is outraged.  No one notices that 95 percent of the physicians are practicing without defrauding Medicare.

Medicine is not a science.  Patients do not all react the same to the same care.  Some patients actually do better on nonstandard care that the “standard of care.”  But fewer and fewer physicians are willing to sacrifice their careers to pointing out that the emperor has no clothes.

There was a time when medicine was not politicized, when, as Dr. Bachararch notes, physicians were collegial. There was no party line requiring adherence at the expense of patients.

In other places I’ve referred to this phenomenon as doctors eating doctors. Ted Bacharach says it much more nicely and much more effectively in “Congeniality, and in the earlier “Friends” and “Who’s the Boss?”

The shame is that his suggestions receive so little feedback. Perhaps the topic is considered too incidental for serious consideration in health care discussions.  Unfortunately, the topic is one of many underlying foundation stones contributing to why our current health care system does not work.

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