In a previous article, I admitted that my criticism of modern medicine had become too broad. I have received excellent care from physicians who looked up from the computer, asked questions, and made me believe they were listening. Exceptional doctors still exist. That admission does not mean the larger problems have disappeared. Caring matters, but caring alone cannot repair the American health care system.
Blaming individual doctors and nurses for the entire cost crisis would be unfair and inaccurate. Physicians generally do not set a drug’s list price. Nurses do not control patents, hospital consolidation, insurance networks, or billing rules. Research identifies pharmaceutical pricing and market protections, the prices charged for medical goods and services, and administrative complexity as major reasons the United States spends so much on health care. Those are system problems that require action from lawmakers, insurers, hospitals, and industry leaders.
Still, that does not let the medical profession off the hook. Clinicians decide whether to order another test, prescribe a heavily marketed drug when a lower-cost alternative would work, or spend a few additional minutes explaining that a patient may not need medication at all. Low-value testing and treatment waste tens of billions of dollars while exposing patients to side effects, false-positive findings, and additional procedures. Research on high-value care shows that clinicians can improve these decisions when medical knowledge is joined with reflection, good role models, and a workplace that supports responsible practice.
I have seen medical professionals offer that different path. They have talked with me about weight, sugar, physical activity, stress, anxiety, sleep, and the daily decisions that either improve or slowly damage our health. Those conversations are not a substitute for medication when medication is necessary. They are part of good medicine. In the Diabetes Prevention Program, an intensive lifestyle intervention reduced the incidence of type 2 diabetes by 58 percent among people at high risk, outperforming metformin during the study period. Sometimes the best prescription begins with an honest conversation about how we live.
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Some people may ask what gives me the right to speak about the health care industry. My response is simple: I am a patient. I am the person who seeks medical professionals when my body aches and I need help. I also spent my adult life responding when other people needed help. Across the United States, more than a million career and volunteer firefighters serve their communities, along with hundreds of thousands of sworn state and local law-enforcement officers and nearly 283,000 paid EMT and paramedic jobs. Those categories overlap and come from different reporting years, but they demonstrate the size of the public-service workforce.
People picked up the phone, dialed 9-1-1, and we answered. Most of the people I served with did not expect to become wealthy. We did the work because it mattered and because our communities depended on us. I am not suggesting that physicians, nurses, or anyone else in health care should work for free. Medical education is demanding, and clinical responsibility is enormous. Professionals deserve to be paid fairly for their knowledge, judgment, time, and sacrifice. The issue is whether income, corporate influence, or organizational pressure becomes more important than the patient.
There is no single solution. Better price negotiation, greater transparency, simpler administration, and payment systems that reward value instead of volume may help. Elected officials have an essential role because many problems are created or reinforced by law and policy. But leadership must also come from inside hospitals, clinics, professional associations, nursing units, and examination rooms. Say no when a treatment adds cost without meaningful benefit. Explain why the newest drug is not always the best drug. Protect patients from unnecessary care as seriously as you protect them from undertreatment.
Joseph Lister, drawing on Louis Pasteur’s work on germ theory, introduced antiseptic surgery in 1867. Many American surgeons resisted his ideas. That resistance became part of the tragedy surrounding President James Garfield’s treatment after he was shot in 1881. Lister did not transform surgery because change was easy. He questioned accepted practice, faced resistance, and kept presenting evidence.
Some things change while others remain the same. Medicine has changed in ways that would have seemed impossible in Lister’s time. The patient’s basic need has not. We still want to be seen, heard, respected, and treated as a person rather than a diagnosis, billing code, or market opportunity. That is not the entire solution to America’s health care crisis, but it is a place where every medical professional can begin.
Christopher H. Foster is a director of emergency services.
