October 2016

Having practiced medicine for the past fifty years, periodically a number of innovative thoughts and concepts have come to my mind or to my attention. These may vary from time-tested procedures that have been traditionally accepted but are frequently less than effective, to more recently developed initiatives. Time does not necessarily dull the senses and indeed, may enhance one’s level of perception. An accumulated knowledge-base often becomes a source from which many concepts can be derived, particularly those that can provide significant benefit to patients in need of help.
As the judicial system, the insurance sector, managed healthcare and politicians increasingly dominate and regulate medical practice, the patient seldom, if ever, obtains benefit from their well-advertised “improvements”. Gatekeepers cling to perspectives that are outdated and coupled with a lack of understanding of illness and how to deal with it in a compassionate, humane and intelligent manner add to the already substantial impediments to the delivery of quality patient care.

Commissions and the ubiquitous high-priced consultants, who are frequently retained to fortify or maintain positions verging on ignorance, similar to the oppressions originating in the legal and accounting arenas, add nothing to the equation. Invariably, the majority of regulatory decisions are designed to “work” the system in order to advance the personal vested interests of the proponents only.

MD’s are human and therefore fallible. The pressure currently exerted on every aspect of their activities does not necessarily make them better doctors, indeed the reverse would appear to be the case. As I have often stated, all the legislation in the world cannot make bad doctors good, but can certainly make good doctors bad. Torn between the imposition of billing codes and the subtle unrelenting pressures of the pharmaceutical industrial complex to which they frequently appear to have outsourced their brains, they lose sight of the patient and their problems.
Needless to say, a thorough revision of the entire educational process should be mandatory to facilitate change. This includes training and education at all levels.

To be productive, the human organism must be allowed to think independently to engender the creativity required to facilitate progress, rather than to be suppressed by the rigid minds that seek to totally control how medicine and related activities are conducted. Codes are no substitute for passion and regulations can serve as major impediments to highly effective care.

Addressing these issues should be the predominant objective in current day healthcare systems; rigidity and over-regulation provide benefit to no one and negatively impact human endeavor, including treatment outcomes. In an era where with new technologies so much more is possible, less is being accomplished; moreover, accountability has literally disappeared.

Ethics committees, often composed of a cross-section of professionals and individuals selected ad hoc, theoretically presenting a cross-section of the community, all too often unite in order to repress the productivity of the individual human mind, which when left to its own devices, can often accomplish so much. The potent human factor is being destroyed by the so-called “logic” of those who would endeavour to enrich themselves through the misfortune of others.

One must always be aware of the tremendous and growing influence big pharma and other gatekeepers have on medical education, in addition to the impact on the actual practice of medicine. These influences serve only to strangle both intellectual and technical progress and in the cold light of day, can only be deemed regressive forces.

Just recently, I was playing golf with two acquaintances and one of them, a physician, had recently referred to me a patient for consultation. The latter was a 27-year-old individual who seven years earlier, was involved in a major automobile accident. Since that time, he had been suffering in what may best be termed “extremis”.

While taking his history, the patient held his head in his hands, stating that he had suffered from wrenching, excruciating headaches 24/7 since his accident. During the course of questioning, he actually broke down in tears. This condition made his life unbearable, despite the dozen or so medications that had been prescribed to him and which were no doubt compounding his pain and agitation. In my mind, no human being should be allowed to suffer in this manner, while insurance companies, lawyers and others decide his fate, totally failing to comprehend the anguish to which the patient is subjected on a daily basis. Meanwhile, the attending physician and other specialists, who from time to time are consulted, stand by, having given up in their efforts to advocate for improvement of the patient’s status.

I offered to treat this patient at my personal expense, but was forbidden to do so by the representatives of the judicial system and the insurance company involved.
The other member of our group happened to be the father of a 32-year-old who had also sustained a severe MVA at age 25 and had been in total limbo ever since; living at the family cottage in relatively acute distress and requiring the constant care and observation of another family member. All remedies available had failed him. His mental and physical condition had steadily deteriorated while the family went through three sets of legal representatives, none of whom provided any relief. Without question, the latter individuals are engaged in these endeavors purely to achieve their own mercenary objectives, sometimes even conspiring with each other for personal gain and invariably at the patient’s expense.

While the charts of these unfortunate patients “age”, physicians stand by helplessly and sometimes not even caring while making the patient’s condition worse by over-medicating. Meanwhile, the charts are maturing and legal fees continue to mount. Many diverse professionals derive profit from the never ending assessments requested by legal representatives and physicians working for the insurance companies; realistically haggling over what is best for them and seldom, if ever, with any real consideration of the patient. Clearly, these legal proceedings are not only reprehensible, but should be termed criminal activities. At the same time, politicians knowingly stand by without initiating drastic reforms to rectify these matters.

Why governments tolerate this untoward behavior is difficult, if not impossible to explain. At the same time, realistically, we all know those patently obvious reasons for this state of affairs – economics and greed.

The injured, who are suffering from symptoms that may be unbearable, are being literally destroyed without any reasonable or timely expectation of a normal life, while facing a society that is totally immune to their suffering. Not only is their own life intolerable, but also that of the families who attempt to care for them and are also being destroyed by these erosive events.
The patient, at the direction of the insurance company, may be shunted from specialist to specialist, each of whom prescribes additional medication, compounding the problem, masking the correct diagnoses and denying appropriate therapeutic solutions.

Thousands, if not hundreds of thousands, around the globe are drowning in this ocean of neglect and who cares about this? No one except their own families, in the best of situations.
Unfortunately, the complexity of the problems involved is generally not understood, nor the simple solutions that exist and should be applied.

How long must this charade go on? Obviously forever, or until the patient loses their sanity or expires: a solution for everyone except the patient.

In a civilized society, these matters should be declared unlawful and it is long past the time that these injustices should be redressed.