Changing Cultures

By Author: Steven Johnson
Total Articles: 490
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Go back a few generations and the world was a simpler place. Even those living in the cities lived in small communities where most people knew each other. Everyone knew the local doctors. They were responsible for bringing all the babies into the world and easing the pain of those dying. It was an all-in-one service, built rather more on altruism than a desire for profit. Yes, there were doctors who only accepted the rich as patients and charged them accordingly, but the majority of doctors were in small practices and directly interested in the health of those they saw. Times and culture changes. The young today cannot imagine a world in which such a situation was possible. They are brought up on a diet of House and Grey's Anatomy which show doctors working in shiny hospitals. Only rarely do we get to see a fictionalized version of the first response as in Private Practice which spun off Dr Addison Montgomery from Grey's Anatomy and shows her living a relaxed life with a handful of well-heeled patients. Such is the mythology of life as a modern doctor. We can all be amused when Sue Lowden, a Republican trying to run against ...
... Senator Harry Reid, suggested turning up for a consult carrying a chicken (hopefully dead). A hundred years ago, bartering for services was part of the way of life. Today, it's a joke with younger people mocking Sue Lowden for suggesting it should apply today.

In fact, our largest bartering company is called ITEX Payment Systems and it has more than one-thousand doctors and dentists prepared to barter for their services. If you can walk their dogs, mow their lawns or perform any of the services required to earn virtual dollars, you can get their services without parting with cash. Yet, for all there are a reasonable number of barter companies running exchanges of value, our culture remain firmly capitalist, i.e. people pay real money for accessing services. The vast majority of doctors today are strictly for-profit. They are reinforced in this by the surrounding commercial interests. Many doctors receive various forms of incentive to prescribe branded drugs. The health insurance companies also contract with doctors to enter into networks where they are to maximize their income by seeing patients for only a few minutes and then prescribing drugs or referring the patients on to others within the network. Everything today has to be fast.

The result is we have the highest consumption of drugs in the world. Instead of healthcare services aimed at discussing options with patients and finding the best treatment available, those in pain are simply prescribed Ultram and asked to make another appointment. Of course, there's nothing wrong with this as a first response to a complaint about pain. Of all the less addictive painkillers, this drug is safe and effective. It's not unreasonable to prescribe it. Indeed, because of the scale of advertising, many of us probably walk in, see a doctor, and ask for Ultram by name. We've been conditioned to believe the answer to pain is always delivered by taking a drug. In reality, this is not the best response. Unfortunately, we need to change our culture to get better responses and that's going to be difficult.