Healthcare and the art of medicine are on the verge of annihilation. Science of medicine is being taken over by decisions made by bureaucracy, monopoly and erroneous facts. People are laying their trust in technology and technocracy (ever) than before. Patient’s conviction of the healthcare is at an all-time low, as they are taking the matter into their own hands. The radical socio-political movements are on the rise, such as Anti-vaccination association against scientific evidence. Citizens are more and more considering homeopathic medicine over allopathic treatment. According to a recent survey published in the American Journal of Public Health, homeopathic medicine use jumped by 15% in 2012 and continues to rise. Doubtless, patients are dissatisfied with the way they are being cared for. According to another study published by the Journal of American “Medical Association, 1 in three physicians has been sued; by age 55, 1 in 2 hits with a suit”. There is a multitude of motivation for this trend, the most prominent on the list is malpractice or deviation from the standard of care which causes mental or bodily damage brought upon the patient as the result of direct clinical decisions made by a physician within the context of their professional association. The former is an example of the simplest scenario describing the realm for patient distrust. With the advent of corporate medicine and managed care system, the legal proceedings have become even more complex. The reasons for the increasing litigants are many but some of the triggering factors are summarized within the context of this discussion later in this piece.
Patient care entails a solid Doctor-patient relationship
In order for a legal action to be warranted or in the other end of spectrum patients pursue an alternate course of action for medical care there needs to be a clear disruption of the relationship between patient and the physician. The bond between the patient and physician and the mutual respect between both parties is by far the most rudimentary to the institution of quality care. It is personal and resistant to intimidation or substitution. Nonobservance of the doctor-patient relationship is usually the prolific ground for an alternate plan of action by the patient such as a lawsuit, anti-healthcare or pursuance of homeopathic treatment modalities. Any element that interferes with the sacred role of the physician, and the patient are deemed disruptors of clinical judgment. For example, recent Corporate and their one size fit all Protocols have forced physicians to practice at the bottom of their expertise by occupying the clinical decision-making space by taking time away from the valuable communication phase with administrative tasks. Similarly, growing government mandate has inflicted a significant burden on physician practices by shifting scrutiny focus on trails of paperwork and administrative ridiculousness thus cutting time off building rapport with the patient. Or imperfect technologies, notably with respect to utility of the electronic health record (EHR) systems have comparably increased the thrust on the medical community. In consideration, faulty solutions have created a vicious circle of unrealistic mandates that has triggered physician burnout, patient alienation and thus healthcare system failure.
Politics, Monopoly and oratorical attitude
Healthcare has become extremely political. It has developed into a sectarian weapon in pursuance of ideological war. The further it is politicized the further differences of opinion will evolve hence fostering further distrust leading to more irrational public attitude regarding wellness and health.
Monopoly, kickback practices are not only unethical and potential catalysts to erosive public cynicism but also illegal for physicians and healthcare providers. Those who contemplate such action can unimaginably face federal prosecution. Nevertheless, few large corporations have been immorality granted licit immunity from sequels of exercising negotiated bribery, as we witness with pharmaceutical, pharmacy benefit management (PBM) and insurance companies. Double standard on monopoly, unilateral accountability in favor of corporate entities and lack of transparency is not a mystery to today’s public. The corporate gain of control over medicine and institutionalization of the healthcare system has bundles the multiples of factors that potentially alter the patient’s attitude towards healthcare and medical care alike.
Today we rejoice in the buzzwords such as healthcare for all; healthcare is a right; value-based reimbursement, but it is obvious; we are simply echoing the messages that we would ideally contemplate to hear, Even so, in reality, they have become the subject of reality divergence. In fact, there is no healthcare that can be granted without efforts from others and there are no rights if that right is earned at the expense of someone else. We all agree people everywhere deserve to be healthy and every patient must be able to have the opportunity to receive the kind care they want. However, the baseless semantic assertion is destined to ignite resentment. Health and healthcare misapprehension is the main contributor to chaos by significantly reshaping the Doctor-patient relationship by way of inaccurate rhetorical attitudes. The secondary gain in support of political ideologies and “profiteering” has created an illusion among the common citizens who feel in fact health is the healthcare. Hence, I have conferred about this topic in detail in one of my past pieces.
Consumerism and population health discord
Among many other challenges, Healthcare has also been affected by the quarrel between population health and expanding patient expectation. Consumerist attitude is on the rise. Generally population health functions in contrary to what consumerism represents since It is devised to deliver the leading healthcare substantiated by social determinants at the most feasible cost to a community at a given point of time. In short, population health would necessitate more acquiescent patient attitude for optimal delivery. However, population health does not warrant the same flexibility as personalized healthcare. Latter invariably accounts for individual determinants of health and wellness without prejudice as well as independently incorporating the personal attitude into noble health. Consumer or patient attitude towards health hence involves a personalized approach. Today with increasing access to raw information, knowledge and expectations patients more than ever are in search of better medical care. Patients will not settle for one size-fit-all treatment. Something that population-based healthcare delivery model has not been able to effectively address.
The Indicators of patient distrust
Recently, an article was published in The Malaysian Journal of Medical Sciences, exploding possible Indicators for medicinal Mistrust in Healthcare–A Review and Standpoint from Southeast Asia. The article commented on the relationships with trust as playing an exceptional role in healthcare. It concluded that Relational crack jeopardizes the provision of quality healthcare when trust is taken for granted. In the opinion of the author, some of the indicators were increasing litigation, Poor physician communication skills, Patients’ demand, practice and non-disclosure of alternative therapies. It is imperative to acknowledge the focus of this research as being on Southeast Asian countries which points out that hypothesized indicators are not unique to a specific region as it is also applicable to the United States. And that population health is the common form of healthcare delivery as in the rest of the World. Nevertheless, in the United States, whistleblowing is another potential indicator. Lastly according to a study published at the journal of patient experience Poor satisfaction rate was associated with certain unmodifiable patient-level characteristics, as well as mental health scores, suggesting that patient satisfaction is a complex metric that can be affected by more than just provider performance.
Homeopathic medicine on the rise
Although there may be much rationale for the emergence of homeopathic and integrative medicine one can easily speculate that one important factor for increasing embracement of homeopathic medicine is its least affliction by recent changes in population health, politics and monopoly. They are the kind of medical disciplines that have been able to maintain the appropriate personal attitude. With overtake of corporate bureaucracy and direct dictation on how medical care is delivered Allopathic or western medicine has suffered overwhelmingly.
Evidence-based Medicine (EBM) of modern medicine
The “modern” allopathic medicine has been established on the notion of evidence-based medicine, which is defined as an interdisciplinary approach to clinical practice. It has been gaining ground following its formal introduction in 1992. It started in medicine as EBM or Evidence-based practice (EBP) gradually spreading to other medical fields. EBP is traditionally defined in terms of a “three-legged stool” integrating three basic principles: (1) the optimum available research evidence bearing on whether and why a treatment works, (2) clinical expertise (clinical judgment and experience) to rapidly identify each patient’s unique health state and diagnosis, their individual risks, and benefits of potential interventions, and (3) client preferences and values. Although EBM was intended to deliver the optimal care possible, however, it was also the starting point for introduction of protocols, guidelines designed by selected few at the top of the hierarchy chain like American Medical Association (AMA), thus empowering corporate medicine, Health Maintenance Organizations (HMO) and the insurance industry to easily monopolize the practice of medicine by holding the guidelines or cookie-cutter practice as the shield to deny care for patients. An evidence-based approach to medical practice has simply gone overboard making the healthcare prone to be taken a hostage to protocol-based medicine and subjecting it to bias and prejudice. Which opens a new discussion that in order for us maintains quality care, we need to uphold the way we approach evidence-based medicine, hence the concept of attitude variation.
Significance of attitude is more than a platitude
By definition attitude or point of view is a settled way of thinking or feeling about someone or something, typically one that is reflected in a person’s behavior. Every decision we make in our daily lives is equally influenced by our perspective about such a decision. It is merely applied in science, medicine, healthcare, and technology as well as many other disciplines.
Not long ago I stumbled across a narrative called “The analytical Attitude, Not the Scientific Method, Is the Key”. The author (Lee McIntyre) describes in this article some of the most recently encountered socio-political movements such as anti-vaccination and global warming. He describes such movements as the example of so-called “failed attitude” through the application of “pseudo-science”. According to him some of the most recent scientific claims lack the attitude that a scientist must possess in order to deliver the nuts and bolts of the systematic evidence. In his piece, the author outlines that there’s no such thing as “the systematic method.” The simplistic “observe, hypothesize, predict, test, analyze and revise” model does not describe how most scientific discoveries are actually made. No matter how good the evidence, science can never prove the truth of any empirical theory. The author also speculates there are people who are Pseudoscientists, whom either misunderstand or simply don’t care about the standards of methodical evidence or if they do care, they don’t care enough to modify or abandon their subjective credence.
The article makes an excellent point about holding a systematic attitude when taking an evidence-based approach and that drawing a conclusive to prove a concept does not necessarily ratify its legitimacy. Nevertheless, looking from a different perspective the narration did not take into account the various distinctive disciplines of the science. I presume Lee in his piece was referring to the applied science. Nevertheless, the Science of medicine is the discipline of indefinite variability. For instance, objectively, vaccines may well be proven to be effective in preventing the infectious disease, but no drug or agent is proven of completely to be devoid of side effects, as the matter of fact even the phenotypic manifestation of those side effects may differ with every individual case. This correspondingly supports the author’s premises of scientific attitude. Confirming that scientific attitude must be in synchrony with its counterpart in medicine in order to support flawless healthcare delivery. Science of medicine is the art of patient care. It can only function within the context of the interpersonal partnership between the patient and a physician. Within the medical practice arena supporting sciences are only complementary to the medical attitude. For example, any drug researched, invented and provided for the purpose of patient care by the treating doctor must first undergo clinical trial and in the wake of vigorous validation tailored to individual patient requirements at each and every clinical interaction. An informed clinical decision is ought to be made to the mutual satisfaction of the doctor and the patient. Medical attitude is about respecting humanity dimension of the medicinal science; otherwise, it is destined to conflict with the scientific viewpoint. Soon political Movements in healthcare are the manifestation of such conflicts where applied science within the confines of population health, institutional or corporate bureaucracy utters the course of the medical practice. Such interference is destined to disrupt the institution by which patients have confidence in their doctors and failure to maintain that bond will eventually manifest itself as mistrust in healthcare as a whole.
Influencers of medical and scientific attitude
There is a multitude of influencers to any attitude yet the most commonly encountered today is the over-reliance on standard operating procedures, protocols, clinical guidelines and population health. Politics disregard to individual predilection are destructive to the already shaky patient trust in healthcare. Therefore, it is crucial to consider and touch on the risk/benefit aspect based on medical science offering for every treatment that is proven effective by the applied science. I have touched on this briefly on one of my recent publications.
Healthcare has an attitude problem
Analogous to healthcare there is a conflict of interest between Natural science, applied science and politics. Whither, the order of attitudes does not respect their fundamental role in patient care. In order to be effective, Healthcare must invariably perpetuate the First-line of the decision making and clinical judgement as granted for by the attitudes inherent to medicine, ethics, personal relationship, rule of relativity, individual liberty which in turn respect and utilizes the second line of viewpoint practices by physical, chemical, biological, technical and logistic sciences. Unfortunately, Current systems’ overemphasis on applied science as the first line of stance has left the doctor-patient relationship, ethics, and individuality at the mercy of absolute technology.
Healthcare sentiments need to change
Medical practice is in need of momentous transition from one hundred percent unyielding applied the science-based solution to the discipline of humanity that engulfs the best of all scientific and technological innovations within the confines of its core value. Medical science is about nostrum to the patient as a person and not correcting a set of test results and protocols. Pharmaceutical, imaging, biotechnologies are complementary scientific fields to the treatments offered by the medical science not the other way around.
Medicine is the science practiced between one physician and one patient. Public health attitude within the context of population health is only sound if it furnishes a personalized approach to patient care, contrary to creating a cookie-cutter medicine.
As Hippocrates advised, medicine is the science of healing sometimes; treating often and comforting always, which is considered to be the foundational approach to reintroducing personalized and precision medicine to medical practice, and the ultimate requisite to ensure healthcare without borders.