In looking at the integration of capitalism into medicine, we often see the line blurred between ethics and profit. Doctors go to medical school, not business school; and when we see medicine becoming more and more entrenched in business, we have to ask ourselves, “Is healthcare a commodity or a universal right?” When hospitals become corporate entities, who are we really putting first – our patients or our profit? Does the problem have less to do with fee-for-service compensation and more with the basis of compensation? Do we reward for outcome quality or quantity of procedures? In the wake of all these existing questions, new threats to the doctor-patient relationship arise. Revenue is easier to manage than quality of care, and this creates a conflict of interest that has changed the practice of American medicine.
As an artist, I work with clients. As a businesswoman, I work with customers. And most importantly, as a health volunteer/EMT in training/future doctor, I work with patients. As such, I’m interested in where all these fields intersect. Certainly, a patient is a client; with modern advances in genomic research and individualized healthcare, doctors aim to create personalized, tailored treatment plans for every patient. A patient is a customer, paying a fee for a service. However, within health care professions, we don’t just “work” or “deal” with patients as one might with a client or customer. We treat, counsel, advise, and care for patients. What makes the practice of modern medicine so tedious is the amalgamation of these areas and lack of cross-understanding between them, which can be destructive to the doctor-patient relationship.
Doctors today face pressure to fill quotas and admit patients – not to do no harm, but to maximize profit. They face the lingering threat of malpractice lawsuits. When a patient lies ill in the hospital, it’s the doctor or nurse at their bedside holding their hand – not an administrator, not a lawyer. To bridge the gaps in understanding between all these fields, either businesspeople need to start going to medical school, or the education of our future doctors needs to synthesize the many different facets of modern medicine that they will encounter as professionals, including policy and management.
I often deal with difficult customers as a business owner and artisan. I recently encountered a particularly challenging customer who rush ordered over one hundred dollars’ worth of customized, individually handcrafted miniatures which I did not have in stock and had to create completely from scratch – not to my behest. The online host I use is customer-oriented, and for custom orders in particular I am required to make the whole order before being paid (normally customers simply order something from my listings and I ship their order after I receive payment confirmation). I slaved away at the order for hours, tediously crafting delicate miniatures, only for the customer to complain ad nauseam about things here and there being “wonky” or “smushed”—that one item was too fuchsia instead of “true purple” when it was the requested shade of rich eggplant. In attempt to fix existing issues with the order as best I could, I found it hard to defend myself, afraid that the customer, who promptly decided not to go through with the order, would leave me a scathing review; and this is not the first or last time I will face this kind of dilemma. I often ask for and respect customer input so I can deliver the best quality product, but where do I draw the line? When is my authority as an artisan and businesswomen undercut? How can my online store host protect its buyers and its sellers? Where’s the balance – the obligation that my online store host, myself, and my customers have to each other?
Now, imagine that scenario, only with lives hanging in the balance. As medicine becomes more commercialized, many medical programs and hospitals are adapting relationship-centered care and placing more emphasis on patient perspective in decision-making. While this is clearly important, it’s also important to respect doctors as professionals, not just providers. We now have doctors stuck between a rock and a hard place: their patients, who could sue them, and their higher-ups, who could also sue them. With such a gridlock, it’s hard to make progress in patient care or rebuild mutual trust within the system.
People often ask me why I put up with difficult customers and clients and deal with the stress of running a business and holding down freelance jobs if I’m ultimately pursuing medicine. My company is a charity, not a profit center. I donate a portion of my profits to the local community and the rest I use to fund my international medical expeditions. These are things I’m intensely passionate about. Though my artistic and business endeavors are enjoyable, they are not fulfilling enough to warrant me spending an entire lifetime serving entitled people who don’t value what I do, but it’s worth it because it enables me to pursue things I love.
Now, I hold the task of leading a group of medical volunteers on an overseas project for a program I graduated from a few years back. In acting as a liaison and organizer of the whole trip, I have met many obstacles in trying to prevent other staff from micromanaging, facing interference from our in-country host and responsibly handling the planning. I can personally attest to the difficulty of making all the pieces fit and making sure everyone is working together, while still successfully trying to make a difference in peoples’ lives and provide meaningful health volunteer services.
The future of medicine lies in our ability to educate everyone involved in patient care. Even if we are at some point able to provide healthcare as a basic right, policy and management will remain central to the advancement of healthcare. If we are going to create careers in medicine that extend beyond just medical professionalism to scholarship, advocacy, management, and collaboration, then the way we educate our future health care professionals should blend all these areas. In addition to fundamental system reform, providing a holistic framework and education for physician competency is an essential component to improving the practice of medicine in America.
Corwin, Howard A., Prameet Singh, and Arnold S. Relman. “Sunday Dialogue: Medicine as a Business.” NYTimes.com. The New York Times, 08 Feb. 2014. Web. 13 July 2014.
Cutler, David M. “The Next Wave of Corporate Medicine – How We All Might Benefit — NEJM.” NEJM.org. New England Journal of Medicine, 6 Aug. 2009. Web. 13 July 2014.