Crisis in Confidence in Health System

The erosion of our confidence in the future is threatening to destroy the social and the political fabric of America.  Our people are losing that faith, not only in government itself but in the ability as citizens to serve as the ultimate rulers and shapers of our democracy.

President Jimmy Carter, “Crisis in Confidence Speech,” July 15, 1979

The perfect is the enemy of the good.

Voltaire (1694-1778), Dramatic Arts

September 17, 2012 -   American again faces  “a crisis in confidence”,  in domestic, foreign, and health affairs.  Domestically, we have high unemployment with shrinking incomes.  On the foreign scene, we have an Islamic wave of anti-Americanism in the Middle East.  In health affairs,  we have a lack of faith in the health reform law and loss of trust in the system itself.

From well-intentioned health care reformers, we hear constant chatter and continuous criticism about 30% of medical care being unnecessary, about providers greedily raising prices,  about duplicitous doctors and hospitals hiding mistakes, and about rampant uncoordinated and unaccountable care.  

Much of this criticism stems from doctors in academia – such as Atul Gawande, MD, a surgeon in the Health Partners System in Boston,  and Marty Makary, MD, of Johns Hopkins, another surgeon whose book Unacountable: What Hospitals Won'tTell You and How Transparency Can Revolutionize Health Care, is just off the press.

Martin “Marty” Makary is a physician, author and television medical commentator. He practices advanced laparoscopic surgery and teaches health policy. Makary is known as an expert in patient safety and served in a leadership role at the United Nations World Health Organization for the Safe Surgery Saves Lives initiative. He advocates  transparency in medicine and common-sense solutions to healthcare’s problems, such as The Surgical Checklist, which he developed at Johns Hopkins, and which was popularized in the Atul Gawande’s best-selling book Checklist Manifesto. Makary advocates innovations in healthcare, including videotaping medical procedures so patients can take home a copy for their records, lifting all restrictions on visiting hours in hospitals, and allowing patients to see their doctor’s notes in real-time.

Gawande and Makary are fine surgeons.    They preach from high academic and journalistic perches. They may  be unaware they are undermining confidence in the health system as a whole  and integrity of hundreds of thousands  individual physicians and hospital leaders.    They may driving out much of the good in the system in pursuit of the perfect, which they may feel they represent.  

Some measure of reform is needed,  but over-zealous  reform and regulations, in a profession already overregulated,  drives up costs,  consolidates physicians and hospitals together into overly costly entities,  exaggerates the physician shortage,  produces an overly bureaucratic and politically unpopular law, and causes employers to reduce hiring and investment because of the economic uncertainties and implications of that law.  Confidence in health care can be a fragile psychological  thing, and once shaken, can have adverse consequences.

Tweet:  Public confidence in the health care system can be shaken by too much criticism from top-down experts  removed from the clinical and economic nitty-gritty in non-academic settings.