This is a guest article by Silvio Aladjem MD.

Not long ago, a friend of mine was complaining about delivery of medical care. In so doing, he told me he was missing the good old times when you had your own doctor.

“Is this progress?” he asked me with an angry voice. “Doctors don’t care anymore about their patients”.

His comments were harsh and, frankly, offensive. He, and many like him, got it all wrong. It’s not the medicine, it’s not the doctor. It’s what’s around them that’s a problem, In more ways than one the public at large is partly responsible for where we are. Let’s take a look.

When after the 2nd World War employers started offering health insurance as a benefit to their employees, a Pandora’s box opened. Slowly, but surely, we started giving up our medical freedom of choice. It was not sudden. It was a slow, insidious system that started undermining the entire medical care as we knew it. For a while, people had more than one health insurance policies and profited from that. Some patients were submitting several claims for the same service. The payments received from one policy went to the doctor the other one was cashed by the patient. Sometimes the patient cashed both checks and the doctor never got paid. If you don’t remember, I do. It was a shameless double dipping all around, but patients were happy.

With time, these loopholes were closed. Employers stopped offering health insurance as a perk. If you wanted health coverage, you had to pay the premiums yourself. Many large companies negotiated a special deal for all their employees. That was good because your premium was less than the market. But you were limited in your choices to doctors and hospitals in the network. If consultations with other specialists were needed, it had to be pre-approved. If you were away from home, payments for services outside the net were heavily curtailed. It was your problem.

People complained, but nobody did anything about it. The public accepted what was given to them without a fight. Unfortunately, doctors and hospitals swallowed the pill as well.

The doctor-patient relation and bond started fading away. Insurance companies, and now the Government, slowly but surely, took over the entire medical system. A large number of doctors left their private practices and became hospital employees or retired. Doctors now see whoever comes, when they come, and visits are limited to 15 minutes. In the office of one of my own doctors, there is a sign: “The doctor will address only one complaint during the 15 minutes visit.” Take your pick: headache or stomach ache, what shall it be today? Doctors must see 4 patients an hour, at least. An assembly line system.

Instead of carrying your chart, doctors now have a small laptop where electronic records are viewed. Chances are that throughout the visit, the doctor talks to you while looking at the computer screen, instead of looking at you, and typing. There are a few honorable exceptions, not many, and they are a dying breed. In spite of claims to the contrary by hospitals and other organizations, medical care is not patient oriented any more. One has to adjust to the system. If you called your doctor’s office recently, the first recorded message is that “if this is an emergency call 911 or go to the closest hospital in your area”. A real caring welcoming message!

Patients lost their identity. They did not object becoming a number instead of a patient. Did not object when they became health care consumers, or clients, rather than being patients and their doctors became health care providers. I never understood how one can “consume health” or “provide health”.

Health care is now delivered by a health care system, which is like a black hole. A “health care provider”, be this a doctor, a nurse practitioner, a nurse, a midwife, a technician handling a sophisticated piece of equipment, a lab technician, or whoever he or she may be, is taking care of you. Patients are lost in the system, and everything is system oriented rather than patient centered. There are some notable exceptions like Cleveland Clinic or Mayo Clinic where, believe it or not, medical care is still very much patient oriented.

As this “health system” was being established, I never heard people complaining. They all took it in, accepted it as a fact of life, motivated primarily because patients did not have to pay for it, beyond the monthly premium. Insurance companies or the Government, pays for it. Since it’s free, the system is now abused. Like going to ER or medical offices, for the slightest headache, sneeze, cough or whatever, which will go away on its own, given a few days. A family physician I know, told me that his patient load averages 40 patients a day and less than half of them really had a medical problem justifying the visit. The rest were “complaints”. No wonder prices went through the roof over the years.

Can all this get worse? No question about it. How much worse? As worse as we allow it to become. That’s a fact.

Be healthy.

===================================================================SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so at:

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