A question fundamental to the practice of medicine was posed recently by Dr. Thomas J. Nasca during the president’s plenary at the annual Accreditation Council for Graduate Medical Education (ACGME) conference in Nashville. Nasca, the ACGME’s chief executive and a nephrologist, asked, “Is the current health care delivery system toxic to patients, physicians, nurses, and other caregivers?” Regrettably, the answer is yes. Since the pandemic’s end, the health system is moving inexorably toward an emphasis on what Nasca aptly termed “economic rationality rather than patient care optimization.” In plain English, it’s all about how insurers can make the most money, not what is best for the patient or caregiver.
Physicians have long battled the pernicious influence of the profit motive over patient care in the temple of medicine. Those making medical decisions in this modern world of “economic rationality” are insurance companies, government policymakers, and corporate administrators. They seek to decrease their costs (which increases profit) by placing administrative hurdles between the physician and the patient, thus creating a toxic environment. The system is toxic to patients by denying them efficient access to medical care. The system is toxic to physicians and nurses by complicating with administrative burdens their efforts to deliver quality care. One insurance plan now even requires patients to have a telehealth visit in order to get a prior authorization (PA) before they can see their primary care physician! How ridiculous!
How can our country spend the highest per capita on medical care of all developed countries and have such a toxic system which denies many of the basic tenets of the patient-physician relationship? The problem is that our health system is designed perfectly to maximize profits for corporations and insurance companies by attempting to limit and control physician and nurse interaction (i.e., delivery of care) with the patient. Health care must be reimagined not around the needs of venture capitalists and insurers but rather around the needs of the patients and the needs of those most critical in delivering their care: the physicians, nurses, and other caregivers. Patient care optimization and caregiver autonomy and support must be at the center of our reimagined health care system.
Contact me at drluciuslampton@gmail.com. — Lucius M. Lampton, MD, Editor