The purpose of Thanksgiving is to set aside a specific time to be thankful for the bounty of the harvest. While Thanksgiving, and the holiday season that follows, has evolved into many different things, this is a time of year we focus on giving thanks for our blessings. I am always thankful for my many blessings, but this year I am particularly thankful for my medical practice.
I am thankful for the opportunity to participate in free market medicine. I realize there are places throughout the world this would be impossible. True, free market medicine provides freedom of medical practice for physicians, but it also provides freedom of medical care for patients. It means my patients are not slaves to a system that dictates:
- Who they may see as a provider
- Where they must go for their medical care
- What medical services are available
- How much it will cost for their care
I am thankful for the opportunity to break down barriers thrown up by insurance companies, hospital systems and governmental agencies between individuals and their physicians.
Are you aware of the walls instituted by hospital systems?
“No, you cannot see your physician today at 2:00 pm.”
“No, you cannot have your physician’s email address or cell phone number.”
“No, you can’t see Dr. Smith; you are assigned to Dr. Jones.”
Your insurance company may dictate what hospital system you may use, what diagnoses they will cover, what testing they will pay for and what treatment—including which medications—they will support. They will tell you not only how much your co-pay will be, but also how much your premium will be; and then, may still tell you they will not cover a procedure or office visit. They may mislead you to believe they will pay for an office visit, but if you did not go through their proper “hoops,” will leave you with the entire bill. And on top of all of this, they will still increase your premiums year after year.
In the name of subsidies and so-called “insurance plans” provided by the government (federal or state), it is even worse. Medicaid may pay for a medication in July, but no longer cover it in August, even if they had been paying for it for a couple of years. They may send reports to your physician, making veiled threats that the physician should discontinue medication or change it to something else. To frustrate the physician into discontinuing the medication, they may require new “prior authorizations” on medications patients have been on for extended periods without any problems. Of course this will NEVER be a stated reasoning for the means, but it is a roundabout way of achieving the desired end result.
Quality assessment programs, sold to the public and the societies of physicians alike, are designed to control the practice of medicine, to standardize treatment and to force away any individualization of medical care. I am thankful for the free market medicine practice model, because my policy of “kill as few patients as possible” is my quality assessment program. When it becomes impossible to force physicians into following guidelines instead of using their reasoning power, then the measuring tool for “quality” will become obsolete, and better outcomes (which are often actually the ABSENCE of problems) will become the only measure for true quality of care.
I am thankful for the art of medicine and for those giants upon whose shoulders I stand. I am thankful for patients who seem to understand that all of life is much of an unknown, and that we tread lightly on what we consider “conventional wisdom.” I am thankful for my mentors, for the words of wisdom and the lessons (what to do as well as what NOT to do) I learned second-hand.
I am also extremely thankful for the excellent education I received from kindergarten through residency training. I am also thankful I learned how to study and how to learn on my own. These lessons have enabled me to enjoy a lifetime of learning, while improving my skills, bettering my trade, and thereby bettering the lives of my patients.
I am thankful for free speech, for the ability to write what I’m thinking and publish it for others to read—without fear from the institutions of which I am critical. I am also thankful for a forum whereby folks may choose to read or not read what I publish.
And finally, I am thankful for you—whomever you may be—thanks for reading to the end. Thanks for your attention, and may YOUR blessings be great in number!
~Jenny Powell MD, FAAFP