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Medicine Has Lost Its Way

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Dr. Deane Waldman has written an excellent analysis of our current healthcare system's intrinsic failing and a prescription to improve health care:

Medicine Has Lost Its Way
By Deane Waldman - March 04, 2024

Medical practice has lost its way. Whether the impetus was external or internal, the practice of medicine no longer follows its true ethos. Medical practice must return to its roots, not for ideologic purity but for welfare of patients.

Healthcare (one word) is the system. Health care (two words) refers to a professional care giver’s personal service or work product. For clarity, the latter is medical care.

Proper, correct, ethical medical care is apolitical, non-ideological, and devoid of any value judgment other than the best course of treatment for the individual patient at hand. Care givers treat all who are ill, without regard to race, religion, place of birth, political affiliation, gender preference, or past activities: good doctors treat convicted felons, even terrorists.

Repairing social ills or injustices, past or present, has no place in proper medical practice. Courses in social justice have no place in medical schools. Clinical physicians do not resolve social injustices, practice population medicine, or solve public health concerns. They care for patients retail, one at a time, providing best care for the specific patient at hand.

Proper medical care involves a legally protected fiduciary service contract between patient and provider. Patients have medical autonomy, i.e., sole decision-making authority, and physicians have authority commensurate with their responsibility.

That medical ethos no longer applies to those who practice medicine in the U.S.

The healthcare market has become a federal monopoly: one seller, Washington dictates payments, i.e., supply; as well as a federal monopsony: one buyer, Washington dictates benefits, i.e., demand. Washington is the direct third-party decision-maker for 194 million Americans covered by Medicaid, Medicare, Tricare and EMTALA (Emergency Medical Transport and Labor Act of 1986). Through its insurance regulations, Washington is indirect third-party decision-maker for 139 million privately insured Americans.

Thus, federal government has taken away decision-making capability from both patients and providers. By denying patients’ medical autonomy and taking over physicians’ medical authority, Washington has severed the patient-doctor fiduciary connection – the bedrock of medical ethos.

By custom and law, patients are free to make medical decisions that affect them. The Tenth Amendment of the Constitution guarantees their right to choose, free from government control. By custom and law, only physicians are allowed to practice medicine, without outside, viz., government, intervention in their decision-making.

Medical ethos is based on a patient-doctor fiduciary relationship. The patient alone has the authority and responsibility to make personal medical choices. The patient temporarily cedes that authority, that agency, to the physician who uses that power exclusively for the benefit of that patient. Without this fiduciary relationship, surgery–using a sharp knife to cut open a person–would be attempted homicide.

Washington’s actions during the great CoViD scam is the best proof available for how the federal government has destroyed medical ethos. Using a man-made virus as a pretext for existential threat, Washington effectively imposed martial law, suspending the Bill of Rights. By requiring all Americans to accept injections of incompletely tested experimental (never used before) gene therapy–mRNA injections masquerading as a vaccine–Washington took away medical autonomy. Half of medical ethos – gone.

Using greatly exaggerated CoViD danger as justification, federal bureaucrats (many with M.D. after their names) took the practice of medicine away from clinical physicians: the other half of medical ethos. Washington told doctors what they could and could not do for their patients; what drugs, like Ivermectin, were prohibited; and even how to triage critically ill patients. “Crisis standards of care” ordered doctors to care for the underserved in preference to the sickest.

Washington’s censorship during CoViD put another nail in the coffin of medical ethos by preventing the free exchange of information. Reports or recommendations like the Great Barrington Declaration not consistent with the federal narrative were labelled misinformation and suppressed. Doctors cannot practice good medicine without having all the information and all the tools available, not merely what Washington thinks they should have.

The primary reason for widespread dissatisfaction among care providers and the resulting shortage is suppression of medical ethos. Care givers expect three forms of payment for their highly valued services: dollars, respect, and psychic reward. They get none.

By low-balling “allowable reimbursement schedules” (list of payments), Medicaid tells providers their services aren’t highly valued. It is no surprise that nationally, a third of doctors won’t accept these patients for care. In Texas, more than half of all physicians refuse new Medicaid patients.

Today’s physicians would agree with Rodney Dangerfield: “can’t get no respect.” The massive array of regulations that constrain medical practice shows the federal government doesn’t trust doctors’ judgment. In fact, Washington feels it necessary to protect patients from the doctors!

Taking away medical authority denies care providers their psychic reward, what gets a trauma surgeon out of bed at three o’clock in the morning or the nurse caring for a highly contagious patient.

Being blamed for health outcome inequities is another nail in the medical ethos coffin. These differentials in health status are overwhelmingly due to socioeconomic factors such as poverty, unhealthy diet, crowded sometimes unsanitary living conditions, and poor education, not because of purported systemic racism among healthcare workers.

There is no medical ethos without medical autonomy, without physicians’ authority and absent the fiduciary connection.

Medical ethos can be restored. In fact, it is quite straightforward. Return decision-making authority where it belongs and thus allow restoration of fiduciary relationship.

Eliminate third-party decision-making authority by repealing the rules and regulations that restrict patients’ freedom to make medical decisions and to spend their own money.

Return medical authority to clinical doctors. Bureaucrats, whether government or insurance, should never tell physicians what they can and cannot do for their patients. In medicine, one-size-fits-all produces bad outcomes. In particular, the FDA, CDC, and NIH should never limit doctors’ options. Most assuredly, Washington must never coerce media into restricting what data the public can see. Censorship in the name of preventing dissemination of so-called misinformation is the death knell of good medical science and will offer harm rather than good health to patients.

Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; former director, New Mexico Health Insurance Exchange; and author of 12 books including the multi-award winning Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.



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