Today’s medicine is based on three interconnecting essential components. The principles are in parts synergistic and parts contradictory.1. The Doctor-Patient Relationship:This is the basis of the contract between the two key members of medicine. The knowledgeable MD works for the benefit of the patient and at his behest only. This implies that the Doctor is the principal and unsubordinated provider. Every and any other aspect is secondary to the MD and his knowledge. Thus, a pyramidal hierarchical model is adopted and accepted as being both infallible and inviolate.2. Universality of Care:The basis, while being of pure intent, disrupts the MD – Patient relationship irreparably. The necessity of ‘third party payment’ obliges the patient to be opposite the provider and the MD opposite his employer. Each relationship consists of many aspects besides medicine. All are detrimental to the idealized and now devalued MD – patient relationship.3. The Medical Model:a. The model’s theoretical basis is that one cause results in multiple effects. A singular pinpoint issue will eventually give rise to systemic consequences. This concept reinforces the pyramidal system.b. The magic bullet: Based on the pyramidal- the cascading concept of illness the corollary is the ‘magic bullet’; the idea that there is one cure that has to be discovered and delivered. The avaricious pharmaceutical companies promulgate the myth. In the path of the havoc wreaked by the unholy alliance of believers and cynics, we find the multiple frauds of medical research.c. The providers’ conundrum: The health services are staffed and managed by senior MD’s who cannot and will never reconcile the two fundamental contradictions inherent in the Doctor-Patient model and the Universality of Care.The Medical Model is outmoded and outdated. The ‘single cause- multiple effects’ concepts is wrong. The opposite is true. In other words, the Sociological concept- ‘multifactorial causes – one result’ is more relevant. This abolishes the pyramidal hierarchical and ‘magic bullet’ concepts.Today’s medicine is a bureaucratic mess. Medicine, if it is to be universal, cannot and should not be run as if the Doctor-Patient relationship exists. It does not. It cannot be run ‘economically’ – none of the profit, cost, supply and demand paradigms are relevant or appropriate.Like all Social Services, there has to a budget, policy, a set of priorities, a program, evaluation, and auditing. The service has to serve the public and be managed by the public. It must overcome the ‘easy way out’ of listening to the providers and being led by them. Any social service must serve the common good and not be a sophisticated works committee.There are no real pressures to change. The ‘owners’ of the third party system- the elected representatives of the taxpayer have neither the will nor desire to demand and make the change. The MD’s and the pharmaceutical companies have no reason to make the change. Why should they?The adage of ‘Doctor Heal Thyself’ is irrelevant. The frustrated MD, along with us all calls: ‘Administrator Administer Thyself.’ This will happen when our representatives represent us and not themselves.
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