Monday, April 03, 2006

"Thinly Veiled Political Desire to Deprofessionalise Medicine"

Last month we posted on an ostensible reform of the British system for matching graduating medical students with hospital training positions. The new system would eliminate face-to-face interviewing, and substitute for them a web-based data collection system. In a letter to the Times (UK), senior academics suggested that this system could be easily gamed, and would thus be unfair.

Unlike many stories posted on Health Care Renewal, this one quickly rated a lead editorial in a major medical journal, the Lancet. [Anonymous. UK medical schools: undervalued and undermined. Lancet 2006; 367: 1029.]

After reviewing the facts in the case, the editorial noted, "respected academic clinicians who have dedicated themselves to teaching medical students and preparing them for practice quite reasonably ask why politicians are now involving themselves in the procedures for selecting and training doctors." Thus, "by shifting responsibility for newly qualified doctors this way, the government is creating a cohort of disenfranchised and demoralised young clinicians who feel hampered in pursuing career paths that best suit their talents and patient needs." The editorial concluded, "the Department of Health's unprecedented and mistaken incursion into medical education, together with its covert attack on medical schools, are yet further examples of thinly veiled political desire to deprofessionalise medicine."

Boldly treading into the arena of international comparisons, let me submit that in the UK, health care is dominated by a single large organization, the National Health Service. In the US, health care is dominated by multiple slightly less large organizations, some governmental, some for-profit corporations, and some not-for-profit corporations. Yet the effects of veiled politically, ideologically, or economically motivated desires to deprofessionalise medicine in both countries were often similar. Both seemingly heeded Einthoven's call to break the physician's "guild," by putting managers and bureaucrats over patients and physicians (see related post here). Doing so did not control costs, access or quality, but did give managers and bureaucrats more power and more money.

Instead, maybe both countries need a third way - perhaps I should use another term - a different pathway. Instead of empowering managers and bureaucrats, we need a system that empowers patients and reinforces physicians' (and other health professionals') professionalism. Failing to do so just lets health care's downward spiral continue.


TXMed said...

I am genuinely wondering if you think such a system, that won't sink back into beaurecratic oversight, can be created without patient's shouldering more of the costs of healthcare?

I don't think it can. Even if we reverse the trend of skyrocketing costs, as long as the government or private industry has such a vested interest in healthcare spending they're going to demand oversight of it. And despite that their meddling has had such undesirable effects on the doctor-patient relationship, it is hard to blame them wanting to watch their money.

Less coverage or more oversight seems to be the situation.

Roy M. Poses MD said...

But patients (except the poorest) already shoulder most of the costs of health care. They pay taxes to support government-run systems. In the US, money that could have gone into the salaries of the employed goes instead to premiums for health insurance provided by companies selected by employers.

Yet because government collects the taxes, government bureaucrats feel they have vested interests in how the money is spent. And because employers spend the money on health care insurance premiums instead of paying it out as salary, they feel they have vested intersts in how it is spent.

Individuals ultimately are the source of the money that pays for health care. And IMHO, individuals ought to have some say about how their money is spent on their health care.

opit said...

One current practice that we could do without is the flogging of pharmaceuticals on TV.