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American Healthcare: The Medical Industry and the Businessman/Doctor It seems obvious enough that if a doctor's total income is based partially on bonuses from the HMO with which he (or she) has a provider contract, then the doctor's mind has to be as much on the profit incentive as on the level of patient care rendered. It is a quirk of the human mind to be able to rationalize and justify behavior in self-interest. When the doctor becomes a bottom-line business person in a business environment, much of the professional aspect has to be suppressed or overrriden. Investigation on the world wide web has not led to nearly as much patient-level information as direct questioning posed to people whom I have contacted. Each of the people I have spoken with has been shocked with their first HMO physician contact. As new patients, we anticipated that the doctor would both examine our medical histories furnished by previous primary care physicians and then do current tests in those areas where there had been problems or no evaluations for more than two years. The first call to the doctor's office reveals that the new patient must have an actual complaint. The doctor is not interested in profiles or assessments. The office receptionist even asked one of my contacts "if you only want to come in to get established and have your status reviewed, how can we bill for that?" While the receptionist may not have been tactful, it was a good revelation of how HMO doctors think and how their offices are run. Do not meet a new patient or assess them for preventative care measures. Let them wait until they have internal bleeding or some other urgent reason to contact a doctor (or the emergency room). Of course, radio commercials urge patients to have annual tests that can save lives, if they are performed in time! Presumably, that is for people with good insurance through their employer or those who can afford to pay privately. To this writer, there is an obvious conflict of interest when physicians must decide between their own annual income and provision for their own families, and the level of patient care. It is rather easy to rationalize away many complaints as imaginary, non-critical, inconclusive or just part of the aging process. But the doctor doesn't know for a fact what the patient's condition is until a preliminary test is performed. Cutting down on lab fees for tests is one of the primary ways to cut costs. Another is to refrain from referring a patient to a specialist for confirmation as to condition. Our leadership in Washington is forever moaning about Medicare going broke. What if Congress finally locked up, in trust, Social Security and Medicare funds received from taxpaying workers so that such funds could never be tapped to pay for our needless military efforts overseas (such as the Kosovo atrocity) or to engage in overseas philanthropy when our own citizens aren't properly cared for? What if the judiciary ruled that HMO payouts (bonuses) to contract doctors constituted a conflict of interest to the disadvantage of the patient and the possibility of compromise on the part of the physicians? Perhaps the government is just too busy harassing Microsoft for being successful (while Exxon and Mobil merge) to bother with the HMO errors, omissions and conflicts. Our national conscience seems to be a bit seared on the side of business, and thus the professions themselves have deteriorated. Where is the consumerism that will provoke doctors to demand better insurance companies without medical compromise? Where is the public outcry for equity in medical care? Where is the media in all this? Finally, where is the integrity of the Congress itself, the great perpetrators of the HMO as the answer to American health care? Creative solutions are possible when everyone works together for a solution. The fact is, every one of the entities who could do something have a vested interest in not doing so until their own hides are at stake. That is why we have no creative solutions, only compounded problems with American health care.
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