Power to the people: Patient in command

Blog Essay 32*

Bernard Lown, MD

Benedictions to patient-centrism, patient privacy, patient autonomy — everything-for-the-patient rhetoric — flow from the pervasive PR of the health establishment. The more I hear these jingles, the more my heart skips a beat. At my age I can’t afford arrhythmia’s. My experience as a cardiologist murmurs that these extra-systoles may be auguries of the hereafter.

I have learned that in our market culture, whenever a message is oft repeated, you can suspect a sales pitch. Indeed the patient looms large as a commodity to be seduced by medicalization, to be showered with drugs, subjected to endless tests, imaged to expose hidden recesses of anatomy, probed by magical genetic analyses for the Ur-self, and salvaged by so-called life-saving interventions. At the same time the patient has grown ever more Lilliputian. You the patient, with real or imagined dysfunctional biological machinery, is largely present; but you the sentient human being is largely absent. The contradiction is beyond Hegelian dialectics.

Time Spent with Patients a Critical Factor in the National Health Crisis*

Bernard Lown, MD

That we have a dysfunctional health care system is now widely acknowledged. No longer does one hear that Americans receive the best medical care in the world. Moreover, the US crisis in health is noteworthy for a blatant contradiction. Despite our investing a king’s ransom on health care, one-third of the population is inadequately protected against the unpredictability of illness. The number of uninsured people has reached a staggering 47 million, with an additional 30 million covered merely for catastrophic illness. No other industrial nation comes close to the approximately US$7000 spent by each American annually for medical care.

Mounting health expenditures preoccupy economists and politicians. The escalation is ascribed to an ever-aging population with greater health demands as well as to costly scientific and technological advances. What is largely ignored is the commodification of illness that America’s market-oriented health care system fosters. As is true in business, the underlying intent is maximizing profitability rather than promoting patient well-being. Unnecessary tests and procedures are encouraged. A market-based health system also has significant upfront costs and unavoidable systemic inefficiencies.

Another consequence of the system contributes to its rising costs and malfunction: Market values are the invisible elephant in the doctor’s office. They quench the human dimension in health care and corrupt the doctor-patient relationship. The first casualty is listening. Since listening to a patient consumes much time and is minimally reimbursed, it is most often done in a cursory, hasty manner, leaving the patient frustrated and the doctor uninformed.