Jane Orient, MD, Your Doctor Is Not In: Healthy Skepticism About National Healthcare, Crown Publishers, New York, 1994
Outside management, even with the best of intentions, harms the relationship and distracts from what happens inside. Events within that inner space, the doctor's office, transcend events in the outer space among those who would manipulate or re-engineer what transpires privately and confidentially inside.
These experts include government policy wonks, health insurance leaders , pharmaceutical companies, hospital managers and myriad others who make up the medical-industrial complex.
Outside experts believe they must manage what goes on inside to make health care more effective, efficient, and progressive, even if they have never been inside a doctor’s office.
In the U.S., we spend 80% of the $2.7 trillion on hospitals (20%), the health insurance industry (20%), medical diagnostic and therapeutic equipment, devices, imaging, and medications (20 %); and 20 % on government regulations, managerial, and bureaucratic demands. That leaves 20% for paying doctors, of which 6% goes to primary care physicians and 14% to specialists.
If I may use the jargon of management, doctors are in lower quintile.
However you look at it, the present system represents managerial and regulatory overkill. The outside medical system dwarfs the inside medical system.
Websites like healthgrades.com are grading doctors on the basis of patient satisfaction. Companies like Castle Connolly Medical Ltd, are publishing lists of top doctors as judged by their peers and by their clinical, academic, litigation backgrounds.