Selling Health – Making Medicine a Business and the Patient a Customer
Mr. Shahid (The Patient): “Doctors these days are busy minting money.”
‘The customer is always right’ – a motto impeccably encompassing modern business practices. Similarly, modern medical practices ideally educate and empower the patient with options for treatment of their disease(s), and helps the patient arrive at the most appropriate decision. But can the patient be always right like a customer? Can patients enjoy the same consumer rights as when buying a car?
THE PATIENT AS A CUSTOMER
The proposition of the patient as a customer (who is always right) rightfully empowers the patient but it also opens avenues for misconduct. It can allow them to shop for drugs with addictive or abuse potential, seek undue days off from work, refuse treatment for contagious diseases, undergo unnecessary surgeries and even demand euthanasia. The patient may not be always right!
MEDICINE AS A BUSINESS
In a similar fashion, let us place a doctor in this business model, providing service to a customer (a patient). Naturally, businesses are geared up for profits, with ethical considerations not always on the priority list. The physician is expected to work for the well-bring of the business, instead of the well-being of the patient. This can be done by prolonging the course of the disease – not educating a COPD patient about smoking cessation and favoring a certain brand by prescribing their brand of multivitamins to every patient, regardless of its need.
Other ways of making the quick buck is writing unnecessary labs/imaging among others. A significant chunk of money is lost to unnecessary testing, some of them at the request of patients. This can be likened to patients shopping for health, and doctors/pharmaceutical companies selling services/diseases, where the onus is disease, not health.
If I can’t afford traveling first class, I will buy an economy class ticket. Can this be the case in healthcare?
The commercialization of health and its repercussions are set to induce a paradigm shift in how we see healthcare. It would make healthcare available only to those who can afford it; hospitals would become boutique hotels which only the affluent can afford. Would it be ethically and morally justifiable for the society where the wealthy can undergo a nose job while the child of a peasant requiring heart surgery is on the waiting list? Following would be the effects:
1. The universal access to healthcare will be severely undermined if patients become customers.
2. It would clearly dent the healthcare professional’s role as a life saver and custodian of the sanctity of life.
3. It is counterproductive to our efforts to contain the skyrocketing and sometimes prohibitive cost of health care.
Having said that healthcare should not be converted into a commodity with money as its command center, we must realize that hospitals and doctors, nevertheless, require finances to keep the ball rolling. While I emphasize a fair compensation for all healthcare professionals who spend a fair amount of effort in training, I reiterate that healthcare services are not meant to generate hefty profits (by over testing or other means) and must not be focused on business-for-profit model.
HEALTHCARE FOR ALL vs HEALTHCARE FOR THE AFFLUENT
Healthcare is a basic human right, as enshrined in the Universal Declaration of Humans Rights and reinforced in the Millennium Development Goals – “Health for All”. Additionally, as doctors, we are to treat everybody and anybody, irrespective of demographics, an oath we solemnly pledge. Health should remain a public good, like basic education and potable water.
PS: The excerpt is from a real clinical encounter. Verbal permission was sought, from both the patient and the physician before penning it. Both names changed, for privacy.
About the Author: Danish Henry is a medical graduate from Hamdard College of Medicine and Dentistry, Karachi and his academic research on geriatric depression was presented at the 19th Ain Shams International Medical Students’ Congress in Cairo, Egypt. He completed his internship at the Aga Khan University Hospital. He also undertook an observership at the Stony Brook University Hospital in Long Island, New York. Dr. Danish is preparing for entry into residency and aspires a career in internal medicine and can be reached at [email protected]
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