The Healthcare Credibility Problem
I am a strong supporter of doctors and the healthcare industry in general. I grew up with a stepfather who was a general practicing physician and a surgeon. He was a family doctor in the truest sense of the word. He made house calls, delivered more than 5,000 babies, bartered for fees, and often just waived the charges. He had a God-given genius for diagnosis, and he spoke to his patients in plain English, sometimes very colorful language. But my mother was always quick to remind him, “After all, you are just ‘practicing’ medicine!”
People have a tendency to venerate doctors, and when they heroically save your life, this hero worship can be justified. Our long-time family doctor is another diagnostician extraordinaire, who also happens to be one of my best friends and hunting buddy. When he sewed up my son’s forehead on our dining room table, he too was vaulted into that hero category.
But something has happened to the medical profession and the healthcare industry -- at 15% of the U.S. economy, it has become an industry complete with industry titans -- and as the pandemic accelerated, healthcare’s credibility problem only worsened.
Beginning in the 1990s, many doctors stopped practicing medicine on their own as the medical profession model changed from entrepreneurial to corporate medicine. As doctors and their offices began to be overwhelmed with insurance claim processing, Medicare and Medicaid compliance, malpractice suits, and medical liability insurance issues, doctors saw the hospital-affiliated-clinic model as the way to skip the bureaucratic headaches and allow the professional to focus on practicing medicine. However, corporate medicine brought corporate practices: cutting back time with patients to increase cash flow, more Medicare/Medicaid compliant procedures rather than patient-centric medicine, and outsourced billing and collection systems.
Around the same time, pharmaceutical companies began marketing drugs directly to the consumers. Like the “Mother’s Little Helpers” of the sixties, new medicines were being developed at a staggering pace. Television ads portray every drug as the new panacea for whatever ails you. In fact, consumers become so mesmerized by the truth-in-beauty scenes of a perfect life that they almost never hear the legally required disclosure of contraindications that should scare anybody who listens. “May cause an uncontrollable urge to gamble” one drug ad warned! I remember watching a football game with my 12-year-old son around 2002. One ad for a giddyup (ED) drug kept showing a guy throwing a football at a moving tire swing. As I watched the imagery, I was not paying attention and wondered out loud, “I wonder what this drug does?” My son’s reply was priceless: “I think it makes you throw the ball better.” About ten years ago, a pharmacist told me that the average customer was on five to six different prescription medicines, and several of those were to counteract the bad side effects of the other drugs. The proliferation of pharmaceuticals has even created a spin-off industry for lawyers: 1-800 BAD DRUG!
Cue up the American Medical Association-supported ObamaCare. Not only did I not get to keep my insurance, my doctor refused to see me because I had the Bronze Level health insurance plan from the federal marketplace. Doctors, who had for decades been trying to make ends meet with increasingly lower limits on what Medicare and Medicaid would pay for visits and procedures, were now being forced to accept less from the new federally underwritten health plans being forced upon millions of Americans.
As though all these trends were not bad enough, the COVID-19 pandemic has undermined doctors’ credibility. Doctors can be found everywhere arguing about the merits of wearing a mask, social distancing, excessive handwashing, quarantine time, the efficacy of various treatments promoted by some and castigated by others, and the efficacy and risks of vaccines. Many doctors bemoan the fact that COVID is keeping people from their regular checkups and screenings. My dermatologist diagnosed seven melanoma skin cancers during the first month of the shutdown in 2020, while the number of patients she saw was about one half of her normal workload. She lamented that perhaps an equal number of melanomas went undetected during the same timeframe. People were suffering heart-attack symptoms but would not go see their doctors. Colonoscopies, mammograms, and many other cancer screenings went by the boards. While medical professionals, policymakers, and especially the media whipped up COVID fears, cases of depression and suicides increased dramatically, and now, schools are finding multiple psychological problems among returning schoolchildren.
Hospitals stopped scheduling elective procedures to make room for the onslaught of Covid patients, even though elective procedures have long been the cash cow of every hospital business model. Since this threatened their financial stability, the federal government came to the rescue with cash payments for each confirmed COVID patient treated. This created a perverse economic incentive to make every patient a COVID patient, regardless of their condition. There are thousands of anecdotal reports of doctors wanting to report deaths as COVID-related no matter the actual cause of death.
Most medical professionals recognize that COVID will never be eliminated. We hope to control it and learn to live with it. The world has an aspiration of reaching what is known as “herd immunity,” where the percentage of population that has been vaccinated or has developed natural immunity (antibodies) is high enough that the disease no longer presents a threat to humanity as a whole. The concept gives people a goal and a hope, but instead we have arguments and changing estimates among the medical and scientific communities, about what percentage constitutes herd immunity.
We have now entered the stage where medical professionals and policymakers are proposing vaccine mandates, vaccine passports, and a return to school closures and economic shutdowns as the delta variant of COVID moves through the population. But amid all this vaccination focus, somehow natural immunity is no longer a consideration. This is most distressing since National Institute of Health research suggests that natural immunity is more robust than vaccine-induced immunity. Studies have shown that survivors of the Spanish Flu epidemic of 1918 were immune up to 90 years later. Similar studies show that survivors of the first SARS Coronavirus epidemic in 2003 are still immune. Because of significant skepticism about the credibility of the healthcare system, it is well known that there are possibly tens of millions of unreported COVID cases, and those people likely have natural immunity.
As Miss Marple says, “Good advice is often given, but seldom taken.” My advice to healthcare providers is to stop speaking in absolutes, recognize that there has always been healthy disagreement among medical professionals, and most of all, recognize that when people decline their well-intended advice, it is because the healthcare community has a serious credibility problem. Most of all, healthcare professionals need to remember that, after all, they are only “practicing” medicine.
Paul D. Hoffman has been involved in environmental policymaking and communications throughout his career. He has served as State Director for then-Congressman Dick Cheney, Executive Director of the Cody Country Chamber of Commerce just outside Yellowstone National Park, and Deputy Assistant Secretary for Fish and Wildlife and Parks at the US Department of the Interior. He is currently the publicist for Hope Springs Media and a consultant for Resource Management Strategies. He has a Bachelor’s degree in Economics and Biology from the University of California at San Diego, Revelle College.
Image: Max Pixel
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