by Seth J. Baum, MD

It was not long ago when doctors were the stopping point for the proverbial “buck.” Doctors held a high position in society and their devotion to the medical profession was never questioned. Studying for ten-plus years following college was proof enough that doctors had their hearts and minds in the right place. Insidiously though things have changed. A confluence of events has diminished doctors to mere “providers” of health. Unscrupulous physicians have been exposed, and insurance providers have fostered the evolution of doctor descriptors such as health care providers, HCPs, and now simply “providers.” Other factors beyond the scope of this article have also contributed to doctors’ roles becoming blended in a concatenated web. The bottom line though is that physicians have been rendered indistinguishable from other “providers” such as nurses and physicians’ assistants. It is not that nurses and physicians’ assistants are unimportant; they are anything but that. They are not, however, physicians. Laypeople have been misled to feel pleased and in some way vindicated by this transformation. After all, doctors had become arrogant and inflated, many people say. But the unanticipated fallout from this fall from grace has damaged not only doctors; it has drastically undermined patient care in our nation.

Removing doctors from the highest seat at the “patient care discussion table” created a void. Sadly, the providers of insurance, not health, have filled that void. This predicament has become clearer since the approval of the PCSK9 inhibitors, veritable revolutionary medications for the management of cholesterol disorders. No sooner had these drugs been approved then insurance providers began their attempts to degrade the importance of this new drug class. Dubious calculations have been made to demonstrate that lack of “cost effectiveness” of these medicines. Apparently the value of a human life does not match the cost of the drug. I’ve already written about the callousness of such calculations, but today my focus is on how the diminution of doctors has permitted the power of the insurance providers to flourish. Let’s examine the two most prevalent sequelae inhibiting physicians in their quest to do the best for their patients by prescribing these (and other) medicines when they are indicated.

First, doctors have been brainwashed by many groups – even their own medical organizations at times – to believe that they are the stewards of society’s monetary resources. They are not. Doctors are the guardians of their patients. Period. Physicians were never intended to consider the cost of care when rendering their opinions. Our mission is simple – we must use our knowledge and skill to help our patients be healthy. The only time the cost of a particular remedy should enter the patient physician conversation is when the patient wants it to become a part of the equation. Contrary to the views of many, doctors must not be put in the position of considering cost effectiveness. If we were to make such considerations, most patients in intensive care units, or those stricken by aggressive cancers would be deprived of their treatment. Doctors would become the death panels most of us fear.

Second, doctors have become so inundated by paperwork and recent regulatory requirements (one statistic states that doctors now spend 33% of their day handling such matters rather than patient care!) that they are screaming “uncle.” Doctors are terrified of reimbursement challenges because for us it means having to do more paperwork and clog our support staff with impossible tasks such as pleading with insurance providers on our patients’ behalf. Basically, doctors have been beaten into submission. They are losing the strength and will to fight the system. And who is the biggest loser here? Our patients.

So my suggestion for doctors is this. Let’s take back our seat at the table. Let’s remember why we decided to become doctors – to help our patients. Let’s regain our strength and will to fight on our patients’ behalf.  But to accomplish such tasks we require our patients’ support. And to gain it, we must help them understand what they have lost and how they can reclaim it. Recently the patient doctor relationship has taken on new meaning in clinical medicine. It signifies transparency, equality, and camaraderie in the quest for health. Now we should add another dimension to this relationship. Patients must stand up for their physicians and help them recover their proper role in making healthcare decisions. By so doing we can wrest the power of choice away from the blind deniers of care and hand it back to those who truly care, the doctors.