Decline and Fall of the Health care System/

  

   Something strange has happened to medicine in the last decade or so.  Most of the physicians I studied medicine with and most of the physicians who preceded me had something in common.  Their focus was on interacting with and caring for an individual patient.   I know how corny it sounds to 'modern' folk, but one of my teachers and mentors used to say "Remember, the patient is king", and he actually meant it!  I can imagine the response I would have got a few years ago if I had said that to my students!  A visit to the doctor was an interaction between two people, the patient and the doctor and the focus of the doctor was what the patient was complaining about that brought him to the doctor.   That was called 'The Presenting Complaint' and it was emphasized that it should reflect the patients own words.  I have discussed the significance of a complete history in a previous blog, my point being that if at the end of the history taking the doctor couldn't locate the system which was primarily effected by the disease, he'd better ask some more questions.  The step-wise progress of the history and examination was to pin point exactly what was going on in that patient and it took time, usually more than the ten minute consultation which seems to be today's average and the 'one-complaint only per visit' that some physicians have the temerity to  impose.  Treatment aimed solely at symptom relief was an interim measure until a precise diagnosis could be made.  Until then you could label the case as being 'open', in much the same was as a murder investigation remains unsolved, until it's solved.  Both the physician and the patient were aware that there was a missing peace in the jigsaw puzzle and decided how much time and/or money should be committed to finding the missing piece. 

many optional procedure were discussed  and evaluated when the patient had to pay some of the costs, but when everything costs 'nothing', well, why not have an MRI for your headache, whether you need it or not.  After all, you pay enough taxes, you should  be able  to have anything you like!

   When Government took over health care, they weren't interested in individual needs when the numbers were small, they were interested in 'big numbers' needs, because that's where the votes are.  Statisticians helped them a lot, because the information they provided enabled government to calculate the 'vote value' of any maneuver they consider.  In effect, they were able to calculate maximum returns to them, for every dollar spent.  After all, why waste money investigating or treating rare conditions that would only benefit individuals.  The 'evidenced base medicine' evangelists came on the scene like prophets in the desert, promising to revolutionize medicine and this they did.  They made it clear that experience and know-how really don't matter, that any new or under-educated physician was just as competent as the expert and experienced, as long as they followed the algorithms of the 'holy ones'.  They could and they would decide what was worth spending the tax dollars extracted from us and what treatments, according to their lights, should be preserved.  Money wasn't to be wasted on anything that was not substantiated with what they considered to be an appropriate clinical trial, even though in the opinion of some experts many of those trials are questionable.    The administridiots and groups of 'useful' physicians (to provide medical legitimacy to their deliberations) established committees to define profession guidelines, standards and rules and what comprised good care and what did not.   Frequently their guideline was cost reduction and certainly public care was emphasized and individual care discouraged using statistical evidence to suggest it was wasteful and not worthwhile.  The bureaucrats don't care about you.

   The government has worked hard to impose on physicians and other heath care personnel that they are no more than technicians and in no way exceptional.   They have impressed on physicians and nurses that there must be no deviation from  mediocrity and that above average care and below average care are equally unacceptable. Services have increasingly been taken for granted and expectations and demands have become unrealistic and inappropriate litigation is
commonplace.   As government increasingly deals with physicians in an unacceptable manner, they undermine professional standards and ethics and they work hard to fool the public that they are getting good medical care, despite the severe demoralization of the profession.  They are not, but they are getting  exactly what they deserve, because just as the population majority gets the government they deserve, so do they get the health care they deserve.  Canada is eleventh out of twelve in the quality of health care in the first world.  Soon we will rank with third world countries, unless doctors stand up and tell the country how poor our health care is and what is necessary to redeem it.  The administridiots aren't going to do it, so if the public doesn't get behind the initiative for major change, they deserve exactly what they are getting - and what they are going to get.  Further, a demoralized profession is  incapable of providing the traditional high standards of care that most physicians were once proud to provide. 

   if you have nothing to say I take it you like it the way it is.