Most people think doctors and other healthcare providers function independently. People believe that healthcare providers do things the way they do because its what’s best for their patients. Unfortunately, this is so often untrue. What if I told you that American healthcare has been infiltrated by third parties that control nearly every aspect of insurance-based healthcare delivery in the United States? Surprised? The reality is that medical insurance providers, big pharmaceutical companies, and hospitals have doctors in their back pockets. Sadly doctors are all too willing to do their bidding and even perpetuate this toxic cycle.
Whenever a patient has an interaction with a provider these days, the wheel must be reinvented. What I mean is that providers must write an entirely new detailed note and then submit this note to insurance for reimbursement. If medical providers did not have to deal with insurance and electronic health records were mandated to communicate with each other, every patient would have just one note. This note would be a living document. Instead of re-writing a whole new document, providers would simply make small modifications to a patients existing living note. This would save providers time and allow them to spend more time with patients. Insurance companies and the fact that EMRs are not mandated to communicate with each other using a universal API (application programming interface) are the only barriers to such a better way of documenting and communicating. As communication is the leading cause of medical error, imagine the potential for error reduction, should such a practical strategy be implemented.
Most of us understand that the person or entity who pays for something, usually has control of it. Since medical insurance controls who gets paid and for what, they essentially have all the power. If they decide not to pay for medical care or a given medication, providers are often powerless to overturn such a decision. Doctors have lost control of their own industry and the entire country is now suffering as a result. Sometimes I have to call insurance companies and beg them to pay. It is just as sad as it sounds.
These days I see so many patients on more than 10 and often more than 20 medications. Drugs are literally being shoved down our throats by big pharmaceutical companies. But, at the end of the day, big pharma does not have prescribing privileges, medical providers do. As providers, if we want to know who is really responsible for the current polypharmacy epidemic, we need only to look in the mirror.
Academic medicine is doing the American people and community medical providers a disservice in this regard. I listen to podcasts from places like John’s Hopkins and Harvard all the time. I hear specialist recommending the use of expensive medications and pushing for obscenely costly interventions. Literally these academic physicians are advocating for the use of drugs that sometimes cost more than 1000$ a day (so many brand name drugs cost patients {really the American people} between 1,000 and 500,000 a year), and only provide a tiny benefit over a generic medication that costs 0.10$ per day, or no treatment at all. This is obscene. We cannot afford a 350,000$, per year treatment, much less when they offer very limited benefit. Honestly even a medicine that costs more than a few hundred dollars a year better work amazingly if you want me to prescribe it. It seems that these academic physicians are all too willing to do the bidding of big pharma in exchange for a publication or two that could help their academic careers. I find this disgusting.
Furthermore I hear these academic physicians recommending the use of expensive tests and workups for indications, for which, we do not really have good treatments. While this may be beneficial for research, it is ridiculous advice for clinical practice in the community. These recommendations often seem driven by industry and like drugs, are bankrupting us for little to no benefit. This is a total waste.
It is time for the American people to realize that their healthcare system has been completely compromised by greed. It is also time to accept the fact that academia, and the incentives of research, are driving academic leaders to publish studies recommending treatments with tiny benefits and obscene costs. We will discuss research corruption on the blog soon, in much greater detail!
Doctors and other healthcare providers need to take back healthcare for the benefit of our patients and the ultimate financial viability of our healthcare system. It is time to stop poisoning our elderly with prescription drugs and time for doctors to start calling the shots again. I believe that any truly beneficial healthcare system should be lead by a robust primary care community that calls out academic specialists for their relationships with industry, and boycotts obscenely priced diagnostics and treatments. Lets see more papers recommending de-escalation of medications academia! Every year so many academic papers recommend the addition of a medication and only a few recommend removing a medication.
I started a direct primary care clinic because I wanted to offer patients medical care without the intrusion of medical insurance. I have a point of care pharmacy that only stocks cheap generic drugs that work. I am building an entire clinic around one goal, providing value to patients and removing those things which do not bring value. It is time for us to focus on what really matters and remove everything else from the equation. I ask my physician piers to join me and leave all the corruption and mal-incentives behind! Our patients deserve better than the obscenely high priced snake-oil that many of us our pushing on them. Stop looking to Washington DC to fix these things, they are likely the most corrupt of any of the third parties doctors deal with. They have failed us so fare and will only continue to do so.
Primary care gave away all the power a long time ago. Since then, generalist providers have become the most overworked and underpaid group of doctors. However, in reality, the power is still primary cares to take back. Primary care doctors are still the gatekeepers to healthcare and the most important piece in the healthcare puzzle. It is time for us primary care doctors to stop accepting abusive relationships and take back control of our industry. If not for us than for our patients.
