Tuesday, September 21, 2010

ACA intentionally undermines the Doctor-Patient relationship

The new healthcare law has multiple provisions which disrupt individualized decision-making between the physician and patient. This is no accident. It is by concerted design.

Dr. Donald Berwick, the new head of CMS, wrote the following on the doctor-patient relationship:

“Today, this isolated relationship is no longer tenable or possible… Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority...Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized, individualized decision making.” (emphasis added)

from New Rules, by Donald Berwick

Dr. Zeke Emmanuel and Nancy DeParle want and expect the new law eliminate solo and small group practices. Along with Dr. Robert Kocher, they wrote the following in an article in the August 23, 2010 issue of the Annals of Internal Medicine:

"To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change. The economic forces put into motion by the Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups...

The health care system will evolve into 1 of 2 forms: organized around hospitals or organized around physician groups...Only hospitals or health plans can afford to make the necessary investments in technology and management skills."

Other revealing quotes from Dr. Berwick include:

"I can not believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for the leaders to do."

"I would place commitment to excellence--standardization to the best-known method--above clinician autonomy as a rule for care."

These health care policy makers believe the source of our health care problems stem from the autonomous decisions made by the private doctor-patient team, working together in the best interest of the individual patient.

They are wrong.

They have forgotten that the best interest of the individual patient is the purpose and standard of medicine--both morally and practically. The health of the nation depends on the sum of the health care provided to individuals. Nothing more or less.

Medicine for the masses is meaningless if the lives and health of individuals are sacrificed to the "common good."

UPDATE 9/28/2010:
Worthwhile related posts at Retired Doc's Thoughts:


  1. Keep up the good fight for the morality of freedom, in medicine as in all areas of life!

  2. Robert--

    Thanks fro stopping by and expressing your support.

  3. The doctor-patient relationship is being constantly threatened by national societies that write treatment guidelines. These guidelines are supposedly based on "best practice" and "research."

    Have you done any investigation about how these panels affect the physician-patient relationship? I was recently denied (covered) treatment because one of the national guideline-setting panels said it was not "medically necessary." It really didn't matter what my doctor(s) said.

    It appears to me that we don't have to wait for nationalized health control to interfere with the doctor-patient relationship. We already have it.

  4. Thank you so very much for your help and support in this effort! We have such a long way to go and I am proud to know that you are on our team.


  5. Believing that three hundred million individual Americans can be reduced to a rigid set of priotocols is a result of erroneous group think.
    The core of medicine is to be able to take medical evidence and Taylor it to the specific individual needs of each patient. Thus protocols must be adjusted depending on those needs. Any system that decreases the physicians ability to individualize therapy is inappropriate and dangerous. Instead of saving resources, because of misadventures it will waste resources. Kenneth A. Fisher, M.D.

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