DMV type medicine should not be allowed to replace competent caring physicians writes Marilyn M. Singleton, MD, JD.
A couple of years ago, computer programs, algorithms, and glorified Google searches were touted as the replacements for a physician’s analysis of a patient’s medical condition. Compressed medical research is quite useful for clinicians who are presented with novel situations and have no readily available colleagues with whom to discuss the case. However, the purpose of flow charts should not be to replace the brains of busy clinicians or, worse yet, be a cookbook for the practitioners at drugstore clinics.
Medical technological aids have now jumped the shark. An unbelievable, but - thanks to cell phone video - verifiably true news report detailed how a robot rolled into a patient’s Intensive Care Unit cubicle and a physician’s talking head appeared on the robot’s “face” and told the patient the sad news that he had a terminal illness. While remote medicine is reasonable in rural areas where access to medical care is limited, telling a patient he is going to die from a TV screen is a crime against all medical ethical principles.
We can certainly expect more medicine by proxy as larger corporations and the government take more control of our medical care. The patient becomes secondary to the goal of “value-based care” or some other medically meaningless metric developed by government bureaucrats to give the appearance of managing costs.
It is highly unlikely that the ruling class (aka legislators) or elitist wannabes (aka limousine liberals) would tolerate a robot doctor. And neither should we.
Thankfully, people are waking up to the incremental erosion of their freedoms, and they are using the free market to find ways around being treated like mindless cattle. In California, where there is a 3-month wait for an appointment at the Department of Motor Vehicles (DMV), for a modest fee a private company will get you an appointment in two weeks. For a little more moola, they’ll have a surrogate stand in line in your stead. Almost on cue, our fearless leaders put forth a bill to outlaw the service because it is “unfair.” What is unfair is a monopolistic government service that holds working people hostage to its incompetence.
DMV style medicine is gradually supplanting individualized care. Clinicians are sharing reports of chronic pain patients being harmed by government one-size-fits-all guidelines pulled together in an effort to stem the tide of opioid abuse. Health Professionals for Patients in Pain, a large group of prominent academic and private physicians, have urged action on this issue. In a letter to the Centers for Disease Control and Prevention (CDC) and relevant House and Senate Committees the group advised that “patients not only have endured unnecessary suffering, but some have turned to suicide or illicit substance use” or had their conditions deteriorate.
It would be disastrous to even more patients if this paint-by-the-numbers approach to our medical care were expanded. If - as the Medicare for All bills proposes - all private insurance is outlawed and the government is the sole arbiter of our medical care, what are average people to do? Stay behind the electrified fence and chew their cud?
At a time when depression and suicide are increasing at an alarming rate, the personal touch is more crucial than ever. If you want to ensure that your doctor treats you like an individual, run – don’t walk to a direct-pay or a direct primary care (DPC) practice. For a monthly fee from $10 to $140 based on age, you can receive all basic medical services, lab tests and medications at amazingly low prices. Best of all, you will have an empathetic and humane doctor who has the time to be thorough and whose face is not buried in a computer screen full of metrics and centralized standards.
The patient-physician relationship is the most effective part of doctoring. National Doctors’ Day was held on March 30th. Let’s make it mean something: just say no to cattle prods and robots.
About the Author
Dr. Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed two years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.
Originally published in Issue 2, 2019 of MT Magazine.