American anti-intellectualism and its impact on physicians – KevinMD | Karen S. Sibert, MD | Physician | Nov 2018
Our country is increasingly controlled by corporations throwing their massive financial weight behind any new opportunity for profit, especially in the high-tech and medical spheres where so much money is to be made.
Issues that used to be considered in terms of social or moral values, like crime and healthcare, are now redefined on corporate financial statements, where they are evaluated on the basis of profit or loss, while moral concerns have evaporated under the hot sizzle of high finance.
The “practice of medicine”, once a proud, independent, and highly intellectual profession, has been eviscerated by increasing standardization. Diagnosis is a computed decision tree and treatment is ordered by universal guidelines, in an effort to create “mix and match” or “plug and play” interchangeable “units of healthcare”.
Highly educated, intensely trained, and increasingly experienced doctors are expensive and difficult to control. The very attributes that make them so valuable to patients make them “problematic” in today’s financially optimized healthcare corporations.
In the drive to streamline (and cheapen) our healthcare, more and more is being defined as “routine healthcare” that can be handled by “healthcare systems” instead of individual doctors.
OK, end of rant – on to the actual article:
I’m more sympathetic to the physicians who are giving up on medicine by cutting back on their work hours or leaving the profession altogether.
Experts cite all kinds of reasons for the malaise in American medicine:
- user-unfriendly electronic health records,
- declining pay,
- loss of autonomy.
I think the real root cause lies in our country’s worsening anti-intellectualism.
People emigrated to this country to escape oppression by the well-educated upper classes, and as a nation, we never got past it. Many Americans have an ingrained distrust of “eggheads.”
For a long time, physicians were exempt from America’s anti-intellectual disdain because people respected their knowledge and superhuman work ethic.
The public wanted doctors to be heroes and miracle workers. The years of education and impossibly long hours were part of the legend, and justified physician prestige and financial rewards.
The trap of “evidence-based medicine”
The concept of “evidence-based medicine” gained traction, mandating that every disease and procedure must be managed according to a standardized set of guidelines.
Never mind that science evolves, and that early research findings often don’t pan out in large-scale studies.
Forget that some published research proves to be fraudulent or tainted by conflict of interest.
Ignore the fact that a protocol that works well for one disease may be exactly the wrong treatment for another, and that many patients have multiple diseases.
Individual physician judgment today is presumed wrong if it defies a standardized protocol.
Compliance with checklists is viewed as proof of quality care.
Ezekiel Emanuel, one of the architects of the Affordable Care Act, has even suggested that medical training be cut by 30 percent, as he believes healthcare by protocol makes all that book-learning unnecessary.
In this view, all “providers” are interchangeable pawns.
Today, young physicians start their careers in a world where their advancement and pay may depend on patient satisfaction surveys, and the Internet fuels distrust of medical advice.
They spend their days functioning as data-entry clerks, with more face-time in front of a computer than with patients.
Innovation is stifled. Their clinical decisions are reviewed for compliance with protocols, and their hospitals are run by administrators for whom the delivery of healthcare quickly and cheaply is the main objective.
They fear replacement by mid-level “providers” who can be trained to follow a protocol without question.
Today’s medical students and residents see the dissatisfaction all around them, and they note the growing number of physicians who want to change careers.
Many look for pathways out of clinical care from the start of their training, obtaining additional degrees — in public health, information technology, bioengineering, or business administration — that can lead to creative careers outside medicine.
Some young physicians turn away from clinical care to become entrepreneurs, designing smartphone apps or using mobile vans to deliver IV therapy for hangovers.
The dystopian future
American anti-intellectualism is growing worse. Our national inability to debate political issues with reason rather than emotion is a symptom of this disease.
So is the distrust of higher education and of experts in every field including medicine.
I wonder every day if we are being honest with college students about the future when we encourage them to apply to medical school.
The Association of American Medical Colleges predicts a shortage of up to 120,000 physicians in 2030, both in primary care and specialties.
A third of currently practicing physicians will be older than 65 within ten years. They’ll be retiring soon, and too many young physicians already are looking for an exit strategy.
Even if we train more physicians, if the malaise in American medicine doesn’t get better we won’t keep them in clinical practice.
Unless something changes, we may find ourselves in a dystopian future with only ten physicians who spend all their time in Washington writing “evidence-based” protocols, while people without the education to realize the full implications of what they’re doing will decide at your bedside which protocol applies to you.
Are you feeling lucky?
Karen S. Sibert is an anesthesiologist who blogs at A Penned Point.