An experienced doctor comments about medicine today

This was sent in to us recently:

During the 4 decades of my clinical training and practice of medicine, I always felt a sense of ownership and full responsibility in caring for my patients. What I have noticed over the past decade is a gradual transformation in our health care delivery system and in the attitude of our trainees.
Hospitals are being governed as for-profit corporations, run by administrators and lawyers, rather than by physicians, with the aim of becoming more profitable. The same mentality that runs Wall Street has permeated into our noble health care profession, wherein the physicians delivering health care to the patients are viewed as providers delivering goods to the clients. And, as the practice of medicine has turned into a business-oriented model, administrators and lawyers have gained much influence on doctors’ practice of medicine.
House-staff have adopted bankers’ hours, that is, at 5 or 6 PM their responsibilities end, and they pass their patients on to the night shift. Students and residents are more likely to consult Google than to read medical textbooks or do literature search in order to gain in-depth knowledge of a subject. There is a constant rush to finish rounds and notes and to pass on the responsibility of patient care to the next shift. House-staff spend more time on the electronic health record than visiting and examining patients. Morning rounds consist of reading the night shift notes. Murmurs, crackles, edema, etc. are missed because doctors are too busy at their computers writing billable notes. Patients’ related discussions are more often at computer side than at bedside. Notes in electronic health records have gotten longer while their content has gotten less relevant, though more billable. Attending, fellow, resident, and student notes reiterate the same information, each with 10-15 continuous pages. Our billing is compared with other centers to encourage higher billing levels. Patient satisfaction scores for faculty, which predominately reflect the style of the medical care delivery, rather than its quality, are compared to make the business more attractive to our clients (patients).
In 2002 Professor Richard Cooper et al predicted a future workforce shortage in medicine.1 His efforts resulted in increasing numbers of US medical schools, and thus, less reliance on international medical graduates for residency training. The new US medical graduates, who are an average $200,000 in debt, are, not surprisingly, seeking high-paying jobs as hospitalists, and thus, the subspecialties are seeing fewer applicants. Why would anyone who is already $200,000 in debt spend 2 or 3 additional years in training only to be subsequently hired with an income that is at least $100,000 less than a beginning hospitalist? I anticipate a great shortage in the workforce in many subspecialties in the near future.
Although patients in clinic receive continuity of care, their encounters with their primary care physicians are brief, as he/she spends more time staring at a computer screen typing notes than talking with and examining the patient. Patients admitted to a hospital see a new hospitalist on call every 12 hours, who in turn must consult with many subspecialties in order not to miss a serious issue, as they are unfamiliar with the patient and his/her medical problems. The hospital benefits from the multiple consultations and the patient leaves the hospital with multiple bills.
In summary, I am witnessing the commercialization of the health care system as it focuses on industrial-style efficiency and productivity, and with that, losing its original purpose of one human being giving care and comfort to another. I am witnessing the gradual disappearance of good role models, the giants in pathophysiology who understood best the mechanisms of illnesses, those with extraordinary bedside manners and clinical judgment who cared for the body and soul of the patient in a most compassionate manner.
Although this sounds like an old fashioned and nostalgic dream, I just wanted to get it off my chest and share it with those who may feel the same.
Bahar Basmani MD The Am Jour of Medicine


15 Responses to An experienced doctor comments about medicine today

  1. Tim Holt says:

    You might also be interested in this week’s episode of “Adam Ruins Everything” in which he explains why hospital care is so messed up:


  2. Tim Holt says:

    After going back and rereading this, I had a few thoughts.
    This physician seems good at identifying problems, but not coming up with viable solutions. Isn’t that what physicians are trained to do: Identify a problem and develop a solution?

    I also can’t help but wonder if he indeed is part of the problem. Does he treat his patients as he describes? Does he do it differently? If he does as he explains, then he is indeed part of the problem. Does he use a hospital that overcharges and treats patients like he describes? What does he charge his patients for a standard visit? He blames “big industry” but what about small, doctor owned hospitals? Do they treat patients the same way?

    Do HIS patient notes take up 15 pages as he describes? If so, why?
    If he is concerned about how hospitals are becoming more and more profit focused, what is he doing to stop that?

    Does he support single payer healthcare for instance, that would eliminate much of the paperwork doctors now have to deal with?

    What is he doing to reduce the cost of medical schools so doctors won’t be so in debt when they graduate?

    It is easy, as we have seen in this blog, to point out the problems. It is much much more difficult to come up with workable, reasonable solutions.


    • Communism Sucks says:

      When did it become the responsibility of any individual who has an opinion to resolve the issue they opine about?

      By your own standards, you have no solution and you are part of the problem as well. It is easy “solve” problems when all you have to do is question the intent, quality and integrity of others and tell them what they must be doing wrong.

      Maybe the “problem” with healthcare is that people think it is my responsibility to solve their problems, i.e when did people get to shift their responsibilities onto others and then complain that others aren’t fixing their problem to their satisfaction? I don’t see you advocating any individual go to medical school and be their own doctor.

      Also, why should any school, much less a medical school, offer something that each individual feels is affordable? There used to be a time when someone sold something and anyone who agreed with the price they bought it. People who didn’t agree with the price simply did not purchase the product. Now it seems that, again, someone wants to make others do things that the specific someone feels is “affordable” or “reasonable”.

      How do I get to the point to where I get to make the rules in society? Why can’t I go to Best Buy and force them to sell me a television for a price that I think is reasonable?

      It seems like your solution involves either communism, slavery or outright dictatorship, because as it sits you don’t get to make other people do anything they don’t want to do. Healthcare can never be a “RIGHT” because it isn’t something you can obtain without involving other people.

      Good luck with that, because in your world I bet someone else will be the boss, and you won’t like that any more than you like free society.

      You could become a doctor and give away perfect care for free, starting your own affordable medical school and training others to likewise perfectly care for others, and resolve every one of your questions above.


      • Tim Holt says:


        “There used to be a time when someone sold something and anyone who agreed with the price they bought it. People who didn’t agree with the price simply did not purchase the product. Now it seems that, again, someone wants to make others do things that the specific someone feels is “affordable” or “reasonable”.”

        So when you are having your heart attack, you think you will be negotiating your price?

        “Nope, don’t take me to that hospital. Take me to the one 50 miles away. They are way cheaper.

        Me thinks one doesn’t have much of a choice. Again, I point you to the link about hospital prices below in this thread.

        But I digress. I am too busy plotting my “communism, slavery or dictatorship” healthcare solutions. You know, like they have in Israel, England, France, Canada, Australia, Mexico, and the rest of the world except for the US.


        • The Oracle says:

          Tim has become a big lefty . . . so yes, he wants socialism and communism based health care. I’ve read a bunch of his class/ blog/ teaching things and its all lefty.


          • Tim Holt says:

            What part of “People should not be allowed to die simply because they don’t have money” is “lefty?” I thought one of the basic freedoms is LIFE, as in Life, Liberty and the Pursuit of Happiness.


  3. tickedofftaxpayer says:

    Don’t shoot the messenger. The doctor is right. Healthcare is becoming big business with an eye to parting folks from their dollars through lack of transparency and fear of death. When I ask a healthcare professional how much something will cost, I typically get one of four answers: 1) the actual price, 2) I don’t know, 3) your insurance covers it or 4) it’s for your health. The actual price is a rare occurrence. The last time someone told me my insurance covered it, I had a $2000 out of pocket expense. And in another instance I found paying cash instead of using insurance saved me $40 because insurance allows a higher payment than they charge someone walking off the street is charged (and it would be part of my deductible so I pay that extra $40). The best analogy to today’s system is: imagine you had to shop for food in markets with no prices. You had no other option for getting food. At checkout, you present a shopper card and the color of your card determines how much you pay for what you’ve selected. That is the healthcare model today–your insurance card (or lack thereof) determines your pricing structure. ACA has further exacerbated it by forcing many in private practice to move to groups or government/university run healthcare operations. That makes it harder and harder to find doctors who control their own work patterns. The end result is no real choice based on price or preferred doctor/patient relationship unless you opt for concierge care (which most insurance companies won’t pay for). Rand Paul’s recommendations for a healthcare insurance model are great. The reason there is so much resistance to what he is proposing is that the insurance lobby doesn’t want to go back to a system that actually gave the consumer some transparency and choice and they own most of the Senate.


  4. tickedofftaxpayer says:

    And if you really want to understand how out of whack the system is, consider this. My husband had a heart attack last year and died after 5 days in ICU. He was on Medicare with Plan F. The total charges exceeded $200K. After insurance calculated the allowable rates, the total bill was around $20K and it was 100% paid through Medicare and his supplement. I had no out of pocket cost. What other industry do you know of that can afford to accept 10% of what they bill? Why not bill Medicare and the supplement the correct price to begin with? What would the price be for someone who is uninsured? If single payer gets such great rates, I’m starting to like the concept of single payer. BTW, the hospital was Providence and he had first class care. Sadly, if I had been the patient, I suspect his out of pocket on my costs (deductibles and co-pay) would have been around $12.5K based on my individual insurance plan because I think the “allowable” costs would have been much higher than Medicare and supplement. I do have an annual maximum out of pocket, but if in network and out of network charges apply that is $12,500. To me, this variable pricing is part of what is wrong with the system.


  5. The Oracle says:

    hey Tim,
    People have Life, Liberty and Happiness . . .IF . . . they work for it.
    I work and pay for my OWN Insurance and I expect everyone else to work and pay for theirs. I also dont smoke and a bunch of the things to keep healthy. I go WAY out of my way to stay healthy to REDUCE my health burden to society.
    What most people object to . . . is paying for other’s health insurance.


    • Chico says:

      Truth is, we are all going to die. That’s the key fact that is central to the discussion. The wonders of healthcare able to prolong the inevitable, but not beat it.

      When we talk of Tim’s scenarios, the question really becomes “to what extent do the taxpayers pay to keep someone alive?” We can’t outspend death, so how far do we go?


    • Tim Holt says:

      Oracle: “What most people object to . . . is paying for other’s health insurance.”

      Isn’t that, in fact, the very definition of insurance? Be it health, homeowners, life, auto? You pay into a large pool that pays people who need it. I pay homeowners/auto/life and health insurance each year with the understanding that there is a large pool I can draw on IN CASE I need it. I may need it, I may not. My house may burn down or it may not. I pay anyway.


      • anonymous says:

        The same people complaining about being required to have healthcare insurance don’t complain when when banks require people to have mortgage insurance for home loans, many of which are guaranteed by the government. They also don’t complain about people being required to have auto insurance. But for some reason they think asking people to have healthcare insurance is unAmerican. Gosh golly gee whiz, I wonder why that is?


        • Tickedofftaxpayer says:

          Yes, but my combined home, auto, flood and liability insurance runs less than $4k a year and my deductible is $1k. My health insurance runs over $7k a yearand my deductible is $2.5k. I’ve never exceeded a medical deductible so yes I have issues with the cost.


        • Brutus says:

          What is being sold today is not insurance. It is pre-paid health care.


          • Tickedofftaxpayer says:

            Not really. I would have to be really sick to reach a point where my insurance pays anything. For the most part, I pay for the medical care I use plus pay an insurance premium. Yes, my policy pays for some diagnostic services but most doctor visits come out of my pocket.


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