Forty years as a doctor has given me a perspective and a retrospective on amazing experiences and the great privilege of being part of some of the most meaningful occasions or fateful decisions in people’s lives.
These experiences have run the gamut of human drama: birth, life, death, and infinity – to paraphrase the 1960’s TV series about the Neurosurgeon ‘Ben Casey ‘, perhaps subconsciously imprinting on my then 10-year-old self my future role in life.
During the subsequent 45 plus years of medical school and becoming a Neurosurgeon I have had a front row seat on so many things in so many “systems” of healthcare (county, private, urban, suburban, rural, VA, Operation Desert Storm and “industrialized” corporate medicine) across the country and the world, that ‘deliver’ experiences impacting people’s lives that have become less and less about “health” and “care” and more and more about power, ”policy”, bureaucratic folly, and profit.
Many of the things I have seen and been a part of as a Neurosurgeon have bordered on the miraculous, and other things have bordered on the idiotic such as more and more meetings that are reflective of the corporate and political takeover of the “systems” for delivering care for people’s health. The waste created by the time spent in these inane pro forma committees and pointless meetings that occur at the behest of the “petty dictators” that populate healthcare management today is nothing short of exasperating. And it keeps getting more ridiculous.
No component of management of the cumbersome bureaucracy that has achieved primacy in healthcare delivery is exempt from this waste of time.
The gradual takeover of the healing arts that has usurped authority for patient care from nurses and doctors by administrators, healthcare insurance corporations, and politicians distract focus from the key purpose of the healing professions of nursing and medicine: the patient. The present healthcare “system” is a hodgepodge of competing providers siloed by dysfunctional and often redundant competition driven by wasteful perverse economic incentives.
These market forces are strong and divert the emphasis on the healing arts away from quality and safety of patient care to maximization of profit and conformation to regulations. It is astounding to see all the “support” businesses that have arisen during my career that are peripheral to the actual physician and patient relationship that siphon off valuable time and healthcare dollars.
To know the value of the interactions between patient and doctor as the actual point of opportunity to help someone with their health concerns and hopefully to provide some comfort and aid, is to recognize that progressively this part of the healing arts is threatened. Patient care has become significantly degraded by the intrusion of regulations, administrative oversight, feckless management and consumer surveys. The ‘yelp’ culture influences patient-physician interaction more and more by equating quality of a sacred encounter with the quality of pizza delivery.
The erosion of the humanity of the healing arts has come about by its increasing intrusion by third party payors such as governmental programs (Medicare; Medicaid, Obamacare) and health insurance coverage into decisions literally affecting people’s lives. Throw in the influence of hospital CEOs, medical school Deans, Institutional board members or shareholders and these “stakeholders” siphon off significant dollars that are taken from patient care and investment in medical research. Management of reimbursement for medical care has become a lucrative business that has transformed the healing arts into a business entity called healthcare. The takeover by business of the healing arts is nearly complete and dictates how patient care is allocated. Providing people with health services in the United States in today’s medical-industrial complex (Arnold S. Relman, M.D., 1980) is a case in which the amount of time devoted to counselling and healing is actually a very small part of the physician-patient encounter.
Consequently, healthcare as a business per se is not about helping humans heal, it is about getting paid for doing things for people with illnesses or creating treatment for other physical conditions such as facial wrinkles that are not illnesses. During the Covid-19 Pandemic demand for cosmetic Botox injections continued unabated.
Many valuable things are done in healthcare each day like liberating a person of an excruciatingly painful kidney stone. At other times however, tremendous expense occurs with treating conditions like facial wrinkles with Botox injections and medicalization of other non-medical conditions for profit. The philosopher-priest Ivan Ilich (1926-2002) was one of the first to warn of the medicalization for profit of such conditions.
In my own specialty of Neurosurgery, operations occur daily for conditions which clearly, by pre-operative MRI brain imaging, have a diagnosis with a terrible prognosis. The cost of the false hope generated by these operations for these inoperable or incurable brain tumors is a dilemma that is unresolved since the days of the 1960’s apocryphal television Neurosurgeon ‘Ben Casey ‘.
As such, resources expended in these pursuits might be better utilized if directed toward ways to improve quality of decision-making, safety, and developing leaders committed to the restoration of the healing arts as the principal source of value in patient care.
There is no greater imperative now than for leaders to revise and innovate for true value of taking care of patients beyond the retail nature that is our nation’s healthcare system.
CARTHAGO DELENDA EST
The present “healthcare system” must be drastically reformed. Part of this reformation will require a radical “management-ectomy” involving elimination of parts of the vast administrative apparatus and apparatchiks that suck value away from patient care. Another part will be enabling innovation to improve the safety, quality, and efficiency of patient care.
This concept and mission of shifting the focus back on emphasis of the healing arts is nothing short of revolutionary.
Those with ideals and knowledge of the true value of the healing arts must join to transform healthcare to an emphasis on healing humans and eliminating in the process the waste that is currently the norm.
My perspective and experience come from working as a physician and surgeon in an environment focused on patient care. The ideals that enabled me to be fortunate enough to obtain this profession have inspired focus on aspects of improving quality, safety, cost-effectiveness, and decision-making for humanizing healthcare.
The Covid-19 Pandemic disrupted the myth of the efficacy of control of healthcare management on the safety, quality, access and efficiency of healthcare. The failure of the hospital supply chain and the critical shortage of personal protective equipment is one example of an egregious display of the shortcomings of management of healthcare organizations.
The frontline nurses, physicians, and support personnel who have met head-on the Covid Armageddon deserve nothing less than a full accounting and effort for improving healthcare commensurate with their efforts.
There is hope. Spero dum spem – while I breathe, I hope.
True believers in the lineup that follows are ALL STARS who have joined with me through HealthcareHealingHumans.com to co-create solutions of true value for healing the sick.
“The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.”
Marcel Proust
Please join us!!
George R. Cybulski, M.D., F.A.C.S., M.B.A., F.A.A.N.S.