Archive for May 17, 2011

How Physicians Lost Credibility and Why it Matters: 1

May 17, 2011 4 comments

Contrary to what most of you might believe, physicians had pretty shitty credibility for most of recorded history. While they were a few “superstars” attached to some famous king or feudal lord- the vast majority were seen as worse than midwifes, witches and traditional medicine men.

The two main reasons behind this poor public image were-

1. They could not do much to help their patients- modern surgery started in the 1890s, and modern medicine came into its own only after the mid-1930s.

2. Prior to the early 1900s, their understanding of physiology and pathology was so poor that they frequently hurt more people than they helped.

Modern medicine is therefore a relatively recent concept- about 60 odd years old. I would consider the period from 1950-2000 as the golden age of being a doctor- in terms of respectability and credibility. It began with antibiotics, advanced surgical techniques, useful drugs and ended with aging baby boomers, google and web 2.0.

So why and where did things go so wrong?

A. The average age of the patient and the type of diseases treated by physicians has changed over the years. In the early part of the golden age, the majority of diseases were acute to subacute (infections, accidents, injuries) because the average age of the population was low. Most treatments resulted in complete cures and satisfied patients.

Today the average patient is far older, has chronic diseases and is far less likely to be completely cured. Modern medicine is still pretty shitty at treating chronic diseases with some exceptions (high blood pressure, auto-immune diseases).

B. Doctors and surgeons have already lost a huge amount of credibility by acting in their own financial interests rather than for their patient. The amount of corruption in areas ranging from prescribing questionable new medications, accepting bribes from pharma, directing patients to use their testing facilities, performing useless or harmful surgical procedures has reached unthinkable levels.

In a previous era, such scams could be easily hidden because person-to-person communication was limited by available technology. Today every publicly available instance of misconduct gets circulated on the interwebs and is archived for posterity. Access to such real information has been corroding the image of physicians for the last 15 odd years- though the process has accelerated in the last decade for obvious reasons.

C. A combination of factors from medical tourism, information on the interwebs, patronizing attitude of physicians plus their sparse face-to-face time have created a situation where a significant percentage of the population now sees physicians as rich, black-mailing scam artists who use a guild system to extract money from people without providing good value for money.

Physicians for better or worse are the face of the health care system and will therefore also bear the culpability for mal-actions of hospital administrators, insurance companies and pharma.Their principal threat of job action- aka letting sick people die is not going to help them if they do it on a large scale. Nobody like a murderer who is also a black-mailer, even if they have MD after their name.

Did I mention that well-trained doctors from English speaking countries could be used to replace them? Politicians and bureaucrats will side with physician guilds only if it does not affect their grasp on power and survival.

In the next part I will talk about the consequences and effects of this credibility loss on physicians, the nature of medical practice and society at large.


Who Will Pay Physicians, Lawyers etc in the Future?

May 17, 2011 4 comments

Some careers such as medicine and law are often considered to be far more stable and lucrative than others- though that is changing. However most people who enter these careers still believe that they will be very well compensated in the near and distant future. Even though these professions have strong professionals guilds which restrict the number of entrants in the system- one question is rarely asked.

How can a shrinking economic system afford to keep on paying these scumbags without imploding?

Until the last 40-odd years, professions like medicine and law were well paid but did not reach the absurd levels we see today. Some of you might say that technological advances in fields like medicine and the changing role of lawyers justifies their increased compensation. I disagree..

If anything technology should have brought down the cost of health care- which it would have IF most doctors were not greedy scumbags. How much of the spending on healthcare helps the patient, at a quality of life or outcome level? How much of it is bullshit perpetrated to increase the income of doctors? The same can be said about law- how much of it has net positive social utility?

The rapidly growing post-ww2 economy (1946-1970s) did create a lot of new money and wealth, as did the credit-based version from the 1980s to the mid 2000s. But that was then..

Today we have a real economy that is shrinking, both demographically and monetarily. However the demands on the system- healthcare, pensions etc are growing. So how can you plug the gap between increasing costs and utilization of systems such as healthcare with a decreasing amount of money? The same goes for lawyers- how can a poorer system pay more for less?

While some people, including myself, believe that euthanasia will become increasingly popular- it cannot make a significant dent in healthcare costs for the vast majority of problems which are fixable.

It is certainly possible that doctors might refuse to treat patients unless they are paid a ransom. However doctors often have kids, an office and a place of work which is public knowledge. It is therefore conceivable that a number of them might die in gruesome and unnatural ways once more than a small percentage of the population is not treated. Let us not forget google-type solutions, medical tourism and increasing use of cheaper immigrant doctors.

Ultimately politicians and bureaucrats care about their survival, and WILL throw the medical lobby overboard if retaining them means sinking along with them.

The same is true as far as lawyers are concerned. A significant part of corporate law might be unsupportable for the same reasons as inflated earnings for doctors- there is not enough money under the current economic paradigm.