Mythicl & Modern Medicine (ctnd0 3/22/2021 7:10:19 AM
In the guise of freedom of information, hopes of patients and demands from them of their physicians has skyrocketed. when the ad says' ask your doctor about it' presumes that either your doctor is not up to date on his treatment does not know a better drug exists and you should ask him about it.
Since the advent into, and the transformation of medicine into a trade, other changes have taken place. There are lesser number of males in the profession hitherto dominated by males. women now constitute half the number of medical student and residents. It is about time that happened. It is a good thing. But it also came about that more men saw better opportunities in other fields like finance and information industry making the same amount if not more, with the same degree of effort.
Rules and regulations. As medicine became more complex and non- medical personnel rose in the various positions of control- rules and regulations came out. These were made mostly by academic physicians with little knowledge of the situation of the community and community medicine. Creating unique problems and obstacles. Peer review is one example. In rural hospitals, at one time the main place where medicine was practiced, there was often only one surgeon or one Ob. Gyn . Who would do his or her 'peer review'? So people from other areas were made to do it who did not share the same demographics and were not true peers. Organizations like JCOAH (joint commission of accreditation of hospitals). PRO (peer review organizations) and others were born to over-see and find errors and regulate practice. PRO in particular became punitive if a physician did not order a test which the PRO rule book thought was appropriate 'actions' were taken. Patient charts were reviewed in retrospect. State medical boards became more active. Insurance companies also got into the act and started reviewing charts. Mandates such as to how many procedures a cardiac surgeon had to do a year in order to continue that privilege. What were their morbidity rates. They were openly published in news papers. No consideration was given to the variables of the frailty or risk or other circumstances or other variable This resulted in some surgeons losing their privileges. such things multiplied to the frustration of some surgeons who stopped doing 'riskier' or complicated cases. This also spawned a new kind of physician who practiced nominally but became an employee of a an insurance company to 'enforce' rand oversee regulations as to the adequateness of treatment and number of days in the hospital etc. His job naturally depending on his 'production' of saving the companies money. Days were 'carved' out of a a patient's stay in the hospital if they exceeded the cook-book number allotted. Others left medicine to work at these new organizations. Many other intrusions took place further eroding physician practice of medicine.
Malpractice insurance, or the new term- liability insurance now brought the intrusion of lawyers in medicine , It became a lucrative law specialty. Lawyers paid money to people who followed accidents (ambulance chasers) or advertised in magazines/ radio/ TV soliciting any adverse experience in relation to treatment. Also another 'medical specialty' was born- the medical expert, who testified for the defense or prosecution as the major part of his or her work. (Next academic medicine) to be cntd.
