The Industrialization of Medicine is Unhealthy for Patients

Talk show host Dennis Prager has popularized the phrase, “The bigger the government the smaller the citizen”. Calm and thoughtful people should consider well this premise. It seems that following the news of the European union and from Washington to Sacramento to city councils we are seeing the demise of personal liberty. So it is with health care. As government intrusion and industrial micromanaging overwhelm my medical profession the individuality of patients and of doctors who care for them is crushed. You have heard me say many times that one size does not fit all when it comes to patient care. We are all different, with varied life experiences and unique personalities. Informed consent and refusal require a free flow of information free from coercive forces. Doctors should be free to advise patients of choices based on what is good for the individual. But as medicine has become the purveyance and money engine of government, businessmen and lawyers our choices are being funneled by processes not often born of reason or the spirit of Hypocrates. Individuality does not fit the business model of bureaucrats and cubicle workers. Too hard to count beans if we honor our differences! In plain language, it is too hard to control. So the solution becomes a takeover of our health care in every facet so that choices can be limited, a façade of liability protection created and a sense of order mandated. As the beast grows it devours everything unique and special that was once the sacred doctor-patient relationship.

Last week I attended the biannual OB/Gyn department meeting at St. John’s Regional Medical Center. I have tried for years to be left alone and allowed to use my skills and allow patients their right of self-determination. Treating patients with that sort of individual dignity has led to conflict with the larger controlling machine of industrial medicine. While we are supposed to follow evidenced based medicine and rely on outcomes data to determine good health care policy, this only gets in the way of those who prefer power over preference. This is true today on almost every scale. When it comes to my local hospital I see a clear distinction. While I want to be left alone to provide the right of informed choice to each and every patient and allow other doctors to do the same, the hospital chooses a narrow path laid down by an admittedly dysfunctional committee. They make what often seem to be arbitrary policies sometimes lacking any sort of sound medical reasoning and then force them upon the doctors and nursing staff with little or no input from the rank and file. These blanket, often kneejerk, policies are not thought out beyond the immediate false satisfaction gained by the creating institution. Thomas Sowell calls this Stage 1 thinking. There seems to be almost no thought for the, Stage 2, long term consequences that result in less choice, higher intervention rates and far more paperwork but no evidence that outcomes will be improved. In fact, as we have seen with premature policies surrounding fetal monitoring and VBAC based on opinion rather than hard evidence, outcomes often worsen. At this department meeting we were provided with a list of policies and protocols put in place at my institution in just the past year.

Delivery Privileges for Certified Nurse Midwives (new, restriction)
Professional Conduct (revised)
Emergency Privileges during a Disaster (revised)
Oxytocin Inductions/Augmentation
Epidural analgesia/anesthesia During Labor
Post cesarean section routine orders
Bakri tamponade balloon protocol
Obstetric hemorrhage protocol
Admission and discharge criteria-St. John’s Pleasant Valley Hospital (restrictions)
Vaginal Packing policy
HIV, Preventing perinatal transmission of
Vacuum assisted vaginal delivery protocol
Post c-section routine orders
Admission/Induction orders
Updated 1-page guide to OB hemorrhage protocol (added per anesthesia dept.)
Final OB hemorrhage policy
Foley catheter policy

Now, maybe some of these 16 new policies will do some good but I have never seen any reports that show they were ever proven to do anything prior to their adoption. And with all these policies now in place will there be any evaluation as to whether outcomes have improved? Were things that bad that we really needed 16 new policies?While not all of medicine is yet lost to this sort of micromanaging, it is becoming pervasive. What is essentially gone is the “Art” of medicine. It seems to me that the job of so many hospital administrators these days is to constantly find things to change. It makes them seem busy and important and justifies their salaries but they so often leap before they look. Their premise is always liability mitigation and economics and sometimes just meddlesome. And it is all under the guise of patient safety protocols. As you can see from the list above, as these policies become more massive and micromanaging there is little or no room for the individual. Sadly, in the current monolithic healthcare model there is no going back. Choices in childbirth, caregivers, prescription drugs, facilities and procedures will continue to shrink and the single patient as a unique person model will fade into history. I am still hopeful that creating smaller alternatives such as birth centers and free standing maternity centers unencumbered by massive government or insurance industry oversight will provide an oasis for those pregnant women who desire the freedom to educate themselves and choose their own path. There will be a cost to remain free but it will surely be small compared to the cost of giving up our individuality. Dr F