Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why the chasm between doctors and patients?  It’s all about money.

Shirie Leng, MD
Physician
April 22, 2015
Share
Tweet
Share

shutterstock_231666442

I have been blogging now for about three years, posting once or twice a week and accumulating 240 posts.  I have my little flock of loyal readers and have managed to contribute a few drops in the ocean of the health care policy debate.  But just this month two pieces made some bigger waves, one ending up briefly fluttering about Twitter, the other offered up to the vast and lawless hordes of Reddit.

I doubt that my wisdom, erudition, literary skill, or ability to mix metaphors made these two posts so interesting to so many people.  The subject matter has hit a nerve.  The first post was about how we use and misuse numbers in medicine, and the second made the case that patients are not customers in the retail sense.

The opinions in both cases were pretty much split between people who agreed with me wholeheartedly and those who thought me the most misguided idiot doctor ever to approach a keyboard. Why these subjects?  Why are issues of buying, selling, ratings and statistics in health care so polarizing?  In general commerce, whole industries have grown up around the insatiable need for ratings and deals.  People buy stuff on Amazon based on how many stars it has and how big the discount is.  Why is medicine different?

Maybe it is not different.  There are plenty of people who think health care should be cast into the competitive marketplace and allowed to sink or swim based on quality indicators and pricing.  Doctor rating websites and magazine hospital rankings provide plenty of opinions and statistics about a vast array of measurements of quality.  Recent pushes towards pricing transparency would allow direct comparisons on the price of procedures, tests, and devices.  A health care consumer can theoretically pick a doctor based on a star rating and haggle him or her down on the price of a knee replacement or echocardiogram.  But is that what we want?  To approach our health needs like buying a car or shopping for appliances?

Say you decide to buy a new dishwasher.  First you have to determine that you need a new one, that is, you have to diagnose your problem — “sick dishwasher, terminal condition.”  So you go online to Amazon or Consumer Reports to see which dishwashers get the best ratings.  You notice that the consumer reviews are all over the place.  People either love or hate any given model.  In fact, there are very few middle-of-the-road opinions.  You decide to buy the one with the highest star rating without really knowing or caring that the rating is just a statistical result of positives vs. negatives from consumers who may or may not be anything like you.  You go to Best Buy or Sears to buy the dishwasher you’ve chosen.  The salesperson you deal with wants you to buy a more expensive unit.  The salesperson doesn’t care if you can’t afford it, or if your house is too small, or if the unit is really the best one for your situation, or whether you really need a new dishwasher in the first place.  His job is to get the most money out of you.  Your job is to get the best deal out of him.  Neither of you is at all concerned about the best interests of the other.  Neither of you is looking for a human relationship.  The only thing between you is money.

And that is where the polarization comes from: money.  A wise man once said (OK, the best man at my wedding, but he is super wise), “All marital conflict is about money.”  All commerce is about the money, and since health care is a commodity, bought and sold on a marginally open market, health care is all about the money.

The relationship between doctor and patient has become all about the money as well.  The minute a patient walks into the doctor’s office money is on the table in the form of a co-pay and a request for health insurance information. Resentment around doctor’s salaries blinds people to the administrators and pharmaceutical companies who are pulling in many magnitudes more than your average primary care doctor.  High profile stories of doctors with financial ties to various organizations erode trust.

Many people don’t realize it, but medical students are taught virtually nothing about money.  It never comes up.  Students are too busy learning how to take care of people, the professionalism and ethics surrounding their chosen field, and how to pass all three parts of the U.S. Medical Licensing Examination.  Most graduating doctors know very little about billing and virtually nothing about costs.  You know what graduates know a lot about that sort of thing?  Business school grads.

Money comes between husbands and wives, doctors and patients, buyers and sellers.  Anything that comes between the doctor and the patient sitting in front of him or her separates two human beings and disrupts the relationship upon which we build trust in each other.

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.

Image credit: Shutterstock.com

Prev

Doctors sometimes don't inform patients of bad news.  Why?

April 22, 2015 Kevin 2
…
Next

Don't use essential oils for asthma. Here's why.

April 22, 2015 Kevin 1
…

Tagged as: Primary Care

Post navigation

< Previous Post
Doctors sometimes don't inform patients of bad news.  Why?
Next Post >
Don't use essential oils for asthma. Here's why.

ADVERTISEMENT

More by Shirie Leng, MD

  • The choice between medicine and nursing

    Shirie Leng, MD
  • New technology might help us become more empathetic to others’ suffering

    Shirie Leng, MD
  • Does practice really make perfect?

    Shirie Leng, MD

More in Physician

  • Why don’t women in medicine support each other?

    Jessie Mahoney, MD
  • IMGs are the future of U.S. primary care

    Adam Brandon Bondoc, MD
  • The high cost of gender inequity in medicine

    Kolleen Dougherty, MD
  • Women physicians: How can they survive and thrive in academic medicine?

    Elina Maymind, MD
  • How transplant recipients can pay it forward through organ donation

    Deepak Gupta, MD
  • A surgeon’s testimony, probation, and resignation from a professional society

    Stephen M. Cohen, MD, MBA
  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How community and buses saved my retirement

      Raymond Abbott | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ancient health secrets for modern life

      Larry Kaskel, MD | Conditions
    • How the internet broke the doctor-parent trust

      Wendy L. Hunter, MD | Conditions
    • Why don’t women in medicine support each other?

      Jessie Mahoney, MD | Physician
    • Why doctors need emotional literacy training

      Vineet Vishwanath | Education
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 23 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How community and buses saved my retirement

      Raymond Abbott | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ancient health secrets for modern life

      Larry Kaskel, MD | Conditions
    • How the internet broke the doctor-parent trust

      Wendy L. Hunter, MD | Conditions
    • Why don’t women in medicine support each other?

      Jessie Mahoney, MD | Physician
    • Why doctors need emotional literacy training

      Vineet Vishwanath | Education
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why the chasm between doctors and patients?  It’s all about money.
23 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...