I read recently in the New York Times that a hospital is trying an experiment to cut costs. The insurance is billed a flat-charge for the surgery and follow-up care for a set amount of time (45 days, I believe). Thus, if something goes wrong after surgery and the patient returns to the hospital for more care, the hospital must absorb the costs.
The initial outcome of this experiment will no doubt astonish you: they are finding that fewer patients are returning to the hospital post-surgery. Imagine that. Apparently hospital personnel, from surgeons on down, began taking steps to make sure the post-op complications were minimal. I would be surprised, however, if this becomes standard practice in hospitals.
One of the unpleasant ironies of health care is that the entire health care system benefits from keeping you ill. You keep on returning to your doctor, which helps his bottom-line. You keep on buying more pharmaceutical medications, making them happy. In fact, you might even end up taking a medication to treat the side-effect of your other medication, e.g. you are now taking Viagra to treat the sexual dysfunction of your Prozac. These sorts of “double-wins” occur all the time in our health care system. Botching the medical procedure may bring an initial “darn” from your doctor, but then he can simply do it again and charge you or your insurance all over again. Surely this must lessen the pain.
A parallel view of things emerges as I have thought about the economics of my practice and how it has helped mold my behavior. Although some of my patients will submit on their own to insurance, most pay out-of-pocket, which shifts the terrain. People are always more careful when spending their own money. Never entirely comfortable with promoting myself, I have not been a particularly good businessman. I have come to rely on referrals, mostly from my patients.
The shift from doctor to businessman is disorienting. Whereas doctoring is based on black-and-white lines of professional integrity, business and marketing firmly inhabits the grey. For a doctor trained in our medical culture, self-promotion feels almost seedy, in a used cars salesman sort of way. In my medical school there was not one class taught on the economics of health care or practice management. The message is clear: medicine and business are entirely separate realms. Medical culture grooms doctors to step into organizations where they defer business decisions to others,
I shake my head when people criticize classical homeopathy as placebo. From my perspective, they are blind to the economic realities of health care outside the system. The pressure for outstanding results is intense. I owe my continued existence to dramatic results on patients that have made whole groups of people wake up and take notice. A little bit of placebo effect simply does not cut it. Nevertheless, stellar results are no panacea. Because this means constantly healing people and freeing them from your practice, it requires a constant stream of new patients, never automatic when practicing a discipline that few people understand. Often patients tell me things like, ‘I want so much for my husband to see you, but he thinks this stuff is spooky.”
First-rate work in healing usually requires breaking out of the box. The economics of “breaking out of the box” can be disastrous. I stopped recommending that people pursue classical homeopathy years ago. The pitfalls are many. It feels a bit like encouraging someone to sail off alone into the Atlantic. Even though business must be somehow be kept separate from practice, one bad business decision can sink a solo alternative practitioner. Those with families to support need not apply.
With so much working against change for the better, how do we carve a path between naïve hope that a great new age of mind-body medicine is dawning and cynicism? Institutions in my experience quickly cave in to economic pressures. I have been unimpressed with integrative medicine centers that hospitals create. The genius of alternative medicine lies in a few, mostly solo practitioners who have managed to carve out an economic niche in which to pursue their unique healing passion—a daunting task. Any great new age of mind-body medicine will arrive because of isolated practitioners throwing themselves against the stream.
The good news is that the grass roots drive for a better medicine may gradually even erode the entrenched status quo. This is a slow process, and it is held up by lack of understanding of what it means to deeply heal. When that happens, groups will start to form that support the growth and development of outstanding mind-body healers. More thoughts on this soon.
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