As a physician, I respect the depths, vastness, and the fragility of life. Every time a patient comes to see me, it is my opportunity to See an example of Life, and to engage in this process out of a trusting willingness of that person, with their free will, and they ask me one of the most sacred questions one human can ask another, “Help.” Help this Life. That is really what someone is asking of me. That is the literal translation of any patient consulting with a doctor…help this life. You can see it in their eyes. You can hear it in what they say and you can hear it in their silence. You can feel it and at that moment, nothing else matters. Just Life and their Sacred Request.
Perhaps this sounds esoteric to some, or en pointe to others. My attempt is to express that for most physicians, becoming a doctor is a calling. It is a higher mission, something that pulls at your soul to help. And I believe this has been going on from time immemorial. Cultures have always revered those who help and heal. The relationship between healer and helped has been kept intact, despite strife and famine and plague and war and even ever-changing cultural attitudes. The doctor-patient relationship would always rise from the ashes, ever-present, ever-sacred. But we now have a new cultural shift and this doctor-patient relationship is under scrutiny in the guise of intellectualism and those that believe they automatically know what is best for you.
I came across an article written by one of the architects of The Affordable Healthcare Act, Ezekiel Emanuel. It is aptly titled “The Perfect Storm of Overutilization” and was published in the April 18, 2008 issue of The Journal of the American Medical Association (JAMA). I encourage you to read the entire article here. In this article, Dr. Emanuel discusses his view on the main reasons why healthcare is used by the populace. In fact, he believes it is overused. He believes that healthcare resources should be allocated in a proper direction for the benefit of everyone that is outside the direct doctor-patient relationship.
Specifically, Dr. Emanuel believes that one of the key reasons there is overutilization of healthcare is the doctor-patient relationship itself and the desire the doctor has to help the person in front of him or her. Here are his own words:
Medical school education and postgraduate training emphasize thoroughness. When evaluating a patient, students, interns, and residents are trained to identify and praised for and graded on enumerating all possible diagnoses and tests that would confirm or exclude them. The thought is that the more thorough the evaluation, the more intelligent the student or house officer. Trainees who ignore the improbable “zebra” diagnoses are not deemed insightful. In medical training, meticulousness, not effectiveness, is rewarded.
This mentality carries over into practice. Peer recognition goes to the most thorough and aggressive physicians. The prudent physician is not deemed particularly competent, but rather inadequate. This culture is further reinforced by a unique understanding of professional obligations, specifically, the Hippocratic Oath’s admonition to “use my power to help the sick to the best of my ability and judgment” as an imperative to do everything for the patient regardless of cost or effect on others.
Here we see Dr. Emanuel directly attacking the Hippocratic Oath as something that simply gets in the way. The focus for doctors should be on rationing care for everyone, whether they are sitting in front of you or not. This is absurd. This was not my personal calling. This is not the calling of any physician.
I also take issue with his word of “over”-utilization. What does “over” mean? By what standard, or who’s standard? Simply the financial cost? Who determines that is too much? I think Dr. Emanuel would like to. If a farmer turned on the water main and forgot about it, never paid any attention to it, and simply let the water go into the drain, this would be a form of thoughtless waste, not over-utilization. But if this farmer decided to use a lot of water, to truly ensure that his crops were protected and nourished, and used water in areas remote to his fields, to ensure possible growth there, just in case, would we say they “over”-utilized the water, or just “used” it? I do not agree that doctors in general, when practicing thoroughness for their patients, are “over”-utilizing healthcare…they are just using it. And the patient, whether directly or indirectly, benefits. If a doctor uses a test or procedure that was not appropriate then this is an issue of proper medical training, not a desire to just “over” use the medical system.
From my corner of the debate as a naturopathic physician, we have the need for health/care PARADIGM reform, not simply “healthcare reform.” It is the underlying philosophical ideal of how medicine and the human system is observed and engaged that is one of the largest parts of the problem. It is not the only problem, but I believe it is a priori to the debate. No one is talking about how the medical system needs a shift in medical philosophical approach. The debate circles around the bloated ineffective and massively expensive allopathic medical system of drugs and surgery. It is like a handful of Chihuahuas desperately fighting over a two story high dog bone when right next to them are a multitude of smaller bones ready for the taking, much more accessible and far more effective. The debate circles the idea of the big bone only and the medical consumer believes that is where the debate about their healthcare future starts and ends…who gets to drag away the big bone and how you can get a scrap from it occasionally. I propose that when the cultural shift continues towards a natural healthcare system and approach to healthcare in general, we will experience greater access to healthcare and realize even greater health as a nation. And the most natural healthcare position that exists is the doctor-patient relationship. And we should maintain it.
I do not disagree with everything Dr. Emanuel is proposing in his article. On the surface, there are reasonable points to be considered about conservatively and carefully reigning in healthcare costs. But this should never be at the expense of the patient in front of you.
I propose some solutions for you and the medical system at large:
- Choice. Maintain the doctor-patient relationship as sacred, allowing doctors easier access to decision making regarding their patients, with less government regulations. Both doctors and patients need to stand up and demand this relationship to be maintained.
- Freedom. Establish freer healthcare access to alternative medical professions, particularly those that promote disease prevention, that the patient chooses in coordination with that professional. Prevention is always the best way to lower costs.
- Dignity. Promote a system and culture of self-reliance and personal responsibility regarding healthcare. The doctor should be there, in most cases, to provide the help to the patient to lead them to self-discovery and self-help. This is done through education by the physician and through the popular culture.
To Your (Utilized) Health,
p.s. Here is a chart from Dr. Emanuel describing his Complete Lives System. I encourage you to read more about it here. This is his proposed system that distributes healthcare access based on age and therefore ability to have the “right” to healthcare services. If you are very young or very old, you have lowered access due to limited years lived or limited years yet to live. My one year old daughter, in all her glory, barely registers on this chart. Where do you fall? Where does your family fall on this chart?
Naturopathic Physician’s Oath
I dedicate myself to the service of humanity as a practitioner of the art and science of Naturopathic medicine.
I will honor my teachers and all who have preserved and developed this knowledge and dedicate myself to supporting the growth and evolution of Naturopathic medicine. I will endeavor to continually improve my abilities as a healer through study, reflection, and genuine concern for humanity. I will impart knowledge of the advanced healing arts to dedicated colleagues and students.
Through precept, lecture, and example, I will assist and encourage others to strengthen their health, reduce risks for disease, and preserve the health of our planet for ourselves, our families, and future generations.
According to my best ability and judgment, I will use methods of treatment which follow the principles of Naturopathic medicine:
First of all, to do no harm.
To act in cooperation with the Healing Power of Nature.
To address the fundamental causes of disease.
To heal the whole person through individualized treatment. To teach the principles of healthy living and preventive medicine.
I will conduct my life and the practice of Naturopathic health care with vigilance, integrity, and freedom from prejudice. I will abstain from voluntary acts of injustice and corruption. I will keep confidential whatever I am privileged to witness, whether professionally or privately, that should not be divulged.
With my whole heart, before this gathering of witnesses, as a Doctor of Naturopathic Medicine, I pledge to remain true to this oath.