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Ishika Ghose

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Medicine is NOT an industry. The industrialisation of medicine should stop

The "industrialisation" of medicine is a recent phenomenon.
It has resulted in:
1. Unrealistic expectations of those who can afford it or have access to it.
2. It has taken away from providing "basic affordable" health care to millions and concentrated on "state-of-the-art" for a few.
3. It has diverted both medical teaching and medical practise from basic conversations with a patient to a series of "tests and investigations" which more often than not are designed to help those who "possess the equipment"
4. It has resulted in virtually complete loss of faith, between the treated and the treating , more litigation, paper work and time spent "covering every eventuality" as doctors
5. Like super-markets the "hospital chains" have taken common sense and good food away from local shops and farmers markets to concrete and glass structures where the "shopper" is bewildered and ends up spending more than she/he needs.

We need to understand that the vast majority of us do NOT need expensive, state-of-the-art medical care. We do not need to pay vast amounts of money to "insure" ourselves and neither do we need to pay vast amounts of money to live.

We need to make 80 % of medical care a 'corner-shop" , non-litigious, relationship of trust between doctor and patient.
We should try and stop the uncontrolled proliferation/continuation of the "medical hypermarket". and its attendant "industries --pharmaceutical, device manufacturing, medical tourism - and go back to the basics.

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    May 28 2012: Thank you, Ishika, for voicing what has become its own rampant 'disease' of corporate malfeasance and an afront to every citizen. I live in the USA, and the amount of construction for hospitals, medical facilities, and pharmaceutical companies offices in my area alone (Chicago) is in the multi-billions of dollars and of such opulence that no commercial company would dare build such edificies in this economy for fear of reprisal. This is just one facet of the problem that I see. Its much bigger, and more sinister of a problem, in my opinion.. I do not blame the practitioners.They are just as victimized by this 'disease' as the patients with obscene costs of liability insurance, over-testing for fear of litigations, and more and more incentive to be concerned for their own welfare rather than their patients. I believe you are not alone in your disgust of the evolution of the practice of medicine amongst your peers. We once had a thousand physicians/surgeons march on the state capital building because there were no qualified surgical trauma practitioners in the rural parts of the state (about 4/5) because they couldn't afford the required malpractice insurance and serve their communities. Doctors couldn't afford to serve! So who's running this catastrophe? Like the detectives say: Just follow the money.
    • May 29 2012: RH - you have put it so well "rampant disease of corporate malfeasance". I am going to use that.

      I do not blame anyone - not industry for bringing yet another "profession/vocation" under its umbrella, not practitioners and not patients. What I think is that we should acknowledge the way we are going and change it. The dialogue has to start and it has to take on a momentum which in itself will force change - perhaps not in my life time but change.

      As someone (I forget who), said "the majority are never right"!! Just because this is the way the majority are going in terms of health "care" does not mean that this is right.

      Bring back those people, those thousand practitioners who marched on the state capital building!! Those are the people who we need to change current medical practise. People who care.
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        May 29 2012: I wish I were as kind as you. That's probably why you're the concerned type of doctor you seem to be. But I am trying. How to change it? For me, the problem is: outrageous cost. The way to combat high cost is to provide the same, or similar, service for less. But it's not that simple, is it? I have heard that many people have traveled to foreign countries for medical procedures because they're cheaper. If I run a medical providing service, that's bad news. The problem with that is most people are subjected to their insurance limitations and are not covered for foreign services. The cost of the foreign services are beyond most peoples ability to absorb such a one-time charge. So the 'market' becomes closed. This is 'good news' if I run a service. It limits competition. I can keep prices high, and insurance companies can continue to charge high fees because of the 'high prices' of service in a (effectively) closed market. Very 'fat' producing. There's also limited service providers because of the high cost of entry. There's limited alternative service providers because of medical/insurance/gov't collusion and the realities of the service being provided. On top of this, there's been a culture created that we must pay for 'Rolls Royce' quality - definitely in the best interest of the providors and evident by the style of medical facilities and providor facilities under construction - with mearly adequate service. Again, because of this 'closed market' dynamic. This system feeds on itself and has evolved into this situation which you so eloquently described. Every other industry only dreams of a market like this (except military production. They have it too). Nobody wants to die or be sick, but everybody deserves access to care without 20-30% of their income taken 'just in case'.
        • May 29 2012: RH
          Its all about "approach to life" (and illness/death)- that's the way I look at it.
          Don't know whether most people think of me as "kind". "Weird" is probably more appropriate but concerned they agree!

          I do not have medical insurance. I refuse to have medical insurance because the children I treat are refused medical insurance in my country - the minute someone uses the word "congenital" the insurance companies are out of there and the laws do not favour the children. By refusing insurance I hope that it makes me more sympathetic to those I treat. Stupid? Possibly!

          I am deeply sceptical of the entire insurance industry. It never seems to help when it is most needed.The fine print is illegible and dangerous to your health!
          Insurance has insinuated itself into our lives dangerously.Promising and failing to deliver. One of the biggest cons - before or after ENRON/BARINGS BANK - is for future generations to judge!

          Looking at it in an extremely simplistic way I say - I love Italian food. Good Italian food. On my current earnings, where I live I can probably afford to eat that once a year (or less).
          No insurance.
          if I were diagnosed with something "treatable" I would go and find the best MY money could buy. If it were something dreadful like a cancer with a poor prognosis - I would shout hurray! Throw a party and go somewhere like Brazil and dance for the remaining three months with nothing more to lose and a finite time to do it in. Pack lots of pain-killers.

          This probably sounds terribly irresponsible and "wierd" but this is personal and do-able.
          My concern remains for the children who are the future and for who "insurance" and current industrialised medicine does not work - not in my country.
          Like you I ask "How can we do this?"
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        May 29 2012: I think you may have the answer - not to participate. The system has priced itself out of reality. I agree with your assessment that it is a 'big con'. It has become a privelged for the most fortunate and a dream for the rest. Similar to a hunger strike, our 'insurance strike' could be the one act to raise awareness and ultimate change. Thank you for you.
        • May 30 2012: Or as Gandhiji started it "The Non-Cooperation Movement" ! One of the most effective peaceful movements in history.
          Yes! That is what we need - "We the people - REFUSE"
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        May 30 2012: I apologize for continuing to respond to your comments, but this conversation has had a most profound effect on me. I read about the 'Movement' you referred to. From what I read, it took a couple of massacres to galvanized people to act enmasse. Unfortunately, it is this kind of 'emotional trauma' which is often necessary to get mass buy-in for these types of significant systematic changes. People seem to have to be 'shocked' out of their comfort zone to rally for an issue. It also helps if they have little to lose. Through this conversation I have been led to see that 'reason', rational 'evaluation', and 'consideration', only lead to endless debate and compromise to the point that the originally effective solution is often discarded for an ineffective 'agreed upon' result - which is usually the least interfering for the 'haves', and lacks substance for the 'have-nots'. Capitalistic prosperity seems to solidify this lack of action and marginally effective response (although I understand that the French Revolution was initiated by the middle-class). For mass buy-in, it seems that only drastic emotional response to tragedy is effective. So maybe there are other alternatives. We, as individuals, could decide, like you have, to refuse to participate. Have little to lose or take, yet continue our professions and lead by example.We could take it a step further and organize our own 'communities' of like-minded individuals and seek to do business with them only, as much as possible, and possibly evolve into an actual thriving community. Or, we could spend our efforts not trying to subvert the system, but rallying support for equal economic opportunity so everyone could afford proper care. Yes, these are drastic, or 'pie in the sky', solutions. But this issue is so significant and huge in influence, that drastic response may be the only solution. I see no end to this malfeasance. It's just too big.
        • May 31 2012: Good morning RH

          If this debate makes one person think differently it will have served its purpose as far as I am concerned.

          For every "movement" in this world of ours which has changed people's thoughts and actions there has to be a critical mass and a critical time. It will happen when enough people feel that they have had 'enough of the old system" and they will have change at all costs.
          Sometimes all we can do is instil those thoughts into the minds of others, "debate", throw ideas around and never see anything concrete happening in our individual lifetimes. But we would have sowed the seeds of change and if it is important enough for that "critical mass of people" it wil happen.

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