You’re exactly right. As I tell people, your doctors chose their careers and livelihood over their sacred oath to guard your life. You’re no longer patients. You’re a cash register.
You’re exactly right. As I tell people, your doctors chose their careers and livelihood over their sacred oath to guard your life. You’re no longer patients. You’re a cash register.
I made a point to set myself up so that I would never be held in a career position where I would have to make those choices, but in many other fields, doctors are forced to either advocate for their patient or be safe with their employer and its often very hard to do both because doctors have a lot less power than they used to compared to corporate health care systems.
It's disappointing, although not in the least surprising, that doctors don't have an organization that has advocated for their ability to practice as so many would prefer. Instead, they've passively allowed the entire system to degrade and along with it their autonomy and ability to truly serve patients. If there is such an organization it's so ineffective as to be invisible. I will never forget when, as a young teen in the 60's I asked my mom why we weren't stopping by the cashier to pay as we left the clinic. When she explained "oh, nobody pays, everybody has insurance that pays" I knew instantly what that meant - the system would inevitably be taken over by the very worst individuals, and become a corrupt mess. Why most people can't understand how a system with every incentive to raise prices and no incentive toward efficiency must fail is beyond me. High prices benefit insurance companies, that should be obvious but apparently is not.
"Why most people can't understand how a system with every incentive to raise prices and no incentive toward efficiency must fail is beyond me. High prices benefit insurance companies, that should be obvious but apparently is not."
The fact that we're forced to buy health insurance is another clue that supports what you wrote there.
There are few incentives for delivering quality care either. In fact, it often works just the opposite as we can now clearly appreciate.
Also, the freedom from liability seems to encourage sloppy or harmful work and not only that, but government funding obviously encourages a race for the bucks and the short cuts that typically entails.
The object is to do just enough to get the handouts with little regard for the results. I have a brother, an engineer, who went to Bosnia after the war, with USAID. He was (naively )concerned about quality until a superior took him aside one day and told him that the object was just to spend money. Reminds me of the shocking scandals that took place when the railroads were being built in the USA 150 years ago. Apparently the situation regarding government favoritsm, spending, and graft has only worsened since.
If we cannot abolish monster government, then we should at least abolish corporations, but I doubt that'll ever happen.
Tragically, most doctors today function as little more than hired hands but that goes as well for anyone employed by large corporations. You are smart for seeing the trap and having the guts to avoid it.
It's really sad to think of how many years and how much effort docs have invested to secure their own slavery.
Just as the military seems to be finding it difficult to find good people, medicine will increasingly find that to be true as well. Part of the problem is that the quality of our journalists and politicians has been in a tailspin for decades too.
they get kick backs from pharma. Either in the form of vacations, parties or free fancy dinners. I know this.
So, if you are a doc in a "group", you might be able to decide how to treat your patients conservatively, or you might give in to the pressure of offering a new med that is horribly expensive but "we can give you a coupon". pharma needs people taking meds, Not old meds, new meds
You cite a good example of where it's useful to know about basic psychology: A rational person will tend to choose his own well-being, loyalty to family, friends, tribe, religion, nation, etc. over those of outsiders. There are many other ways that could be phrased: A rational person tends to act in his own self-interest. Sure, there are cases where a person will act altruistically and sacrifice himself for others or for a group, for an ideal he believes in. But that's rare. In other words, you are a fool if you put yourself into a position where you hope someone will put his own interests aside. Hoping that someone will risk his own ass just for you is not a smart way to bet. Note that none of the foregoing says a person so acting is "evil." Yes, surely the would-be beneficiary would be expected to feel that way. Yet the impartial observer would say no, the would be benefactor is merely acting in his own self-interest, and the "victim" is in the wrong, expecting others to act against self-interest.
That's why some knowledge of pop psychology is helpful. For example, consider an economic transaction (and seeing your doctor is one). How is the other party compensated? Complications like the risk of fraud always exist, but a lot can be inferred by knowing actual or likely potential conflicts of interest. Of course it depend upon the situation. For example, in court, plaintiff and defendant optimally want a lawyer who represents their interest only. The judge should be impartial, having no conflicts of interest either way. Alas, the real world is rarely so clear-cut. Oftentimes, the best one can do is to be aware of the actual or probable conflicts of interest and manage how they may influence the other party's behavior.
A final comment: I NEVER was taught anything remotely like the above in school, and I've got a BS STEM degree and a MA in a liberal art. The closest I came to moral insights might have been in various religion teaching I received. Yet the psychology or morality I outlined above is basic stuff. I learned it from articles, independent reading, even from economics texts.
You’re exactly right. As I tell people, your doctors chose their careers and livelihood over their sacred oath to guard your life. You’re no longer patients. You’re a cash register.
I made a point to set myself up so that I would never be held in a career position where I would have to make those choices, but in many other fields, doctors are forced to either advocate for their patient or be safe with their employer and its often very hard to do both because doctors have a lot less power than they used to compared to corporate health care systems.
It's disappointing, although not in the least surprising, that doctors don't have an organization that has advocated for their ability to practice as so many would prefer. Instead, they've passively allowed the entire system to degrade and along with it their autonomy and ability to truly serve patients. If there is such an organization it's so ineffective as to be invisible. I will never forget when, as a young teen in the 60's I asked my mom why we weren't stopping by the cashier to pay as we left the clinic. When she explained "oh, nobody pays, everybody has insurance that pays" I knew instantly what that meant - the system would inevitably be taken over by the very worst individuals, and become a corrupt mess. Why most people can't understand how a system with every incentive to raise prices and no incentive toward efficiency must fail is beyond me. High prices benefit insurance companies, that should be obvious but apparently is not.
Great comment.
"Why most people can't understand how a system with every incentive to raise prices and no incentive toward efficiency must fail is beyond me. High prices benefit insurance companies, that should be obvious but apparently is not."
The fact that we're forced to buy health insurance is another clue that supports what you wrote there.
There are few incentives for delivering quality care either. In fact, it often works just the opposite as we can now clearly appreciate.
Also, the freedom from liability seems to encourage sloppy or harmful work and not only that, but government funding obviously encourages a race for the bucks and the short cuts that typically entails.
The object is to do just enough to get the handouts with little regard for the results. I have a brother, an engineer, who went to Bosnia after the war, with USAID. He was (naively )concerned about quality until a superior took him aside one day and told him that the object was just to spend money. Reminds me of the shocking scandals that took place when the railroads were being built in the USA 150 years ago. Apparently the situation regarding government favoritsm, spending, and graft has only worsened since.
If we cannot abolish monster government, then we should at least abolish corporations, but I doubt that'll ever happen.
Tragically, most doctors today function as little more than hired hands but that goes as well for anyone employed by large corporations. You are smart for seeing the trap and having the guts to avoid it.
It's really sad to think of how many years and how much effort docs have invested to secure their own slavery.
Just as the military seems to be finding it difficult to find good people, medicine will increasingly find that to be true as well. Part of the problem is that the quality of our journalists and politicians has been in a tailspin for decades too.
they get kick backs from pharma. Either in the form of vacations, parties or free fancy dinners. I know this.
So, if you are a doc in a "group", you might be able to decide how to treat your patients conservatively, or you might give in to the pressure of offering a new med that is horribly expensive but "we can give you a coupon". pharma needs people taking meds, Not old meds, new meds
By design. Saw it coming when managed care took hold.
You cite a good example of where it's useful to know about basic psychology: A rational person will tend to choose his own well-being, loyalty to family, friends, tribe, religion, nation, etc. over those of outsiders. There are many other ways that could be phrased: A rational person tends to act in his own self-interest. Sure, there are cases where a person will act altruistically and sacrifice himself for others or for a group, for an ideal he believes in. But that's rare. In other words, you are a fool if you put yourself into a position where you hope someone will put his own interests aside. Hoping that someone will risk his own ass just for you is not a smart way to bet. Note that none of the foregoing says a person so acting is "evil." Yes, surely the would-be beneficiary would be expected to feel that way. Yet the impartial observer would say no, the would be benefactor is merely acting in his own self-interest, and the "victim" is in the wrong, expecting others to act against self-interest.
That's why some knowledge of pop psychology is helpful. For example, consider an economic transaction (and seeing your doctor is one). How is the other party compensated? Complications like the risk of fraud always exist, but a lot can be inferred by knowing actual or likely potential conflicts of interest. Of course it depend upon the situation. For example, in court, plaintiff and defendant optimally want a lawyer who represents their interest only. The judge should be impartial, having no conflicts of interest either way. Alas, the real world is rarely so clear-cut. Oftentimes, the best one can do is to be aware of the actual or probable conflicts of interest and manage how they may influence the other party's behavior.
A final comment: I NEVER was taught anything remotely like the above in school, and I've got a BS STEM degree and a MA in a liberal art. The closest I came to moral insights might have been in various religion teaching I received. Yet the psychology or morality I outlined above is basic stuff. I learned it from articles, independent reading, even from economics texts.
Common sense wins out over the ivory tower morons all the time.
Almost no one truly gives a shit about your problems unless it affects them directly.
Most, yes.