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DNA Helix

Dr. Dilbert

January 6th, 2009 by Andrew Yates

dr-dilbert-motivationalWhen you treat you physicians like Dilbert, it’s Dilbert medicine you’ll get. As 3rd party payers and HMOs continue to divorce expertise from judgment, so results Dr. Dilbert: the highly specialized and well-educated yet ineffective nebbish masochist. American medicine sucks? The problem isn’t a lack of health care management. Insurance and health management organizations do not provide medicine; they “manage” it. You do not stagger into the swanky Blue Cross Blue Shield office lobby so that the receptionist will buzz down a squad of underwriters to stymie your hemorrhaging which you have tracked across their polished floor. You go… to a hospital. You can’t just magically create “medicine” on a spreadsheet. Medicine is physical capital, real labor, and decades of accumulated medical education and experience. More layers of pointy hair to “arbitrage payment” don’t serve patients, they delegate the “bother” of medical expertise and accountability to physicians (excuse me: “providers”) while assuming effective jurisprudence by controlling who gets paid, when, for what, and how.

For example: in the Helix BRCA CliniCast, Dr. Barbara Ward describes how she recommends a treatment as medically necessary, but her judgment is overridden by the insurance company, and without funding, the treatment is not feasible. Resigned, she exclaims she’ll appeal, but she’s just the surgical oncologist, who is she to question the medical judgment of some bureaucrat? Sorry Barb, you’ve been downgraded to “provider.” You’ll have to just wait for HQ to make any decision, just like the guy who installs my cable (though I’m sure he’s quite the coaxial expert, too.)

So, how exactly is adding more and more layers of management to manage less and less wealth supposed to “fix” medicine? Is this Soviet Russia? Is the problem that we “just need a more perfect model?” Or is the problem that “management pretends to pay us, so we pretend to work?” What else can physicians do but pretend when they have 8 minutes to see the patient and after another all nighter of filling out forms? And who’s problem is it if in a decade there will be a drastic shortage of qualified primary care physicians because “management” has made it no longer economically feasible? Not management’s, of course. The problem is that “the people” are lazy and greedy. No worries, they can be replaced. Don’t be such a whiner, Yugo Doctor will still get you from point A to B just fine, right?

Physicians are a specialized intellectual professionals who provide a necessary social service. So why do they tolerate treatment as “providers” by third-party payers and their proxy institutions? Why not simply bill hours at professional rates, just like a lawyer? One could require a retainer, the government provides a civil servants to provide service if its otherwise unavailable, physicians could self-organize into self-governed firms, social work is pro-bono, and the entire system is well understood, established and (maybe too) effective —by example— in the practice of law.

Yet, outrageously, somehow when a physician employs simple billable hours at professional rates… incurs a “crack down?” What kind of bizarro world is this?

Frankly, I had always hated insurance companies and HMOs out of principle because I’m a hater, and hating is what I do. But not until I actually sat down and physically did some real medical administration research did the true black stupid horror of the medical system strike me. There is no fixing this system. The only way out is to opt-out. That’s why I wholly support nationalized healthcare; I have full faith that it will be so corrupt and inept that people will be motivated to finally leave the system —”crack downs” regardless.

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  1. American Health Care Crisis the Fault of Science? | Think Gene
    January 7, 2009 @ 9:11 pm

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