Lessons - Why Public Confidence in Healthcare Is Declining | Brian L. Strom - Medical Ethics Expert

In this lessons episode, discover why more people are turning to herbals and Eastern medicine over conventional Western health care. Learn why a lack of trust in corporate medicine drives patients toward alternative treatments. Understand how diminished doctor-patient interaction fuels this shift and uncover the potential of population-based care models to realign incentives and improve outcomes. It actually seems just very, very anecdotally without the data to back it up. Just through casual conversations, it seems like more people are trying herbals and Eastern medicine and all of these things that don't seem to be Western. And it's so interesting because I think there's cultures that seem to default to Eastern medicine or herbal medicine. I mean, I'll give you an example. Growing up, I didn't, it was just just regular drugs. I don't even know how to describe it. It's just like, it's like Western medicine and doctors and prescriptions and antibiotics and anything else. And then, so my better half, she's a couple different things, but her mother is Jewish, Israeli, and her dad is Russian, and she has tried so many different herbal things to get better. And when she's sick, the default is herbal this or herbal that or try that. And there was like a Chinese doctor that she went to go see one time. I'm like, I don't understand. Any of this isn't from my my world or what I knew growing up. So I feel like, and maybe just that proximity to it, but I also hear it in conversations. Not a complete lack of trust in Western medicine, but some lack of trust in Western medicine. And I'm so curious why you think that's happening. And if I'm incorrect in that assumption, you could tell me that too. But I felt that in conversations. I think you are correct in that assumption. What widely used and the herbal's non-typical treatment isn't trusted, are taken widely, and people instead take herbals and other things. And it does come a lot from lack of trust. Part of it is that given where health care has has come, and that was it is evolved, positions don't spend much time with patients. And as health care has more and more become a business, rather than sort of the solo practitioner doctor who comes to your house and whatever, you know, trust people as much. And again, if you talk to most patients, they'll all say, health care is terrible. It's at my doctor, he's great. And you know, people who have a primary care doctor and unbiased, I'm a primary care doctor, but people who have a primary care doctor typically will trust that primary care doctor. But it's a, when more and more as medicine has become corporate, and as health care has become much more expensive and hasn't become corporate, the times people spend docks spend the patients is less and less. More of that is in front of a computer screen. And so the doctor is interacting with the computer rather than the patient. There's much less trust. And part of what alternative health care providers do is they spend more time with patients in part because they're cheaper. So if you're going to make x dot number dollars per hour, that whatever that clinical specialty is, you know, if you're a surgeon, they want you in the operating room. If you're an anesthesiologist, they want you in the operating room, give me anesthesia, not not spending a lot of time talking to patients. And, and I think it is definitely hurt the trust of medicine. I think the other thing that has hurt ironically was years ago when when the people came out with the 80 hour week, which probably doesn't mean anything to you, but the expanding to your audience. There was a, uh, um, there were people who clueless were hurt and they hit the press because the doctors taking care of them were too tired. And so they put in place a rule for residency we talked before about, you know, treating your treat needs like like dirt as endless slaves as residents, that you're not allowed to work more than eight hours away. Now, the way with the word resident comes from as people, they lived in the hospital. They were resident hospital. They were also about house tech because again, they lived there with in the house in the hospital, uh, accordingly, it was a commitment to your patient that that was inherent in becoming a physician that you would be the nature of professional ethics was your patient comes first and you stay in the hospital till your patients coming well. You do whatever's needed. The 80 hour week rule imposed because of fear that people were too tired made doctors into shipwriters. That at the end of your 80 hours, you have to leave or the program is penalized, um, in accreditation. So it's changed the character of medicine and and our training is completely with with that and and and I think there's a big loss and the big loss to physicians in terms of self-washed, um, but but it's also a big, big loss in terms of patient, patient care. But I think the corporatization of medicine has been a big part of it as well. Do you feel like there's a, uh, an eat not an easy but even any solution to that because I mean, that's not that's not a great path that everybody's going down if they don't trust and and now you have this profit machine that not just profit machine, you have, okay, respecting the, the, the wellness, physical mental of the residents. I understand where that comes into play, but when you're talking about surgeons are in the operating room, anesthesiologists are in the operating room. There's a dollar value attached to every hour of a medical professional. There's this, there's this industrial complex that's driving this behavior very hard to beat an industrial complex. So how do you, how do you create trust or space for medical, medical practitioners, medical providers to have that prime with the patient so they can restore the trust? That seems to be the x factor that has to be solved for. It certainly is one issue. No question, no question. I think one way is we need to to make it make better use of other professions. You don't need a doctor to do everything. So in my career as a primary care doc, much of what I did, you did not need a physician's training to do. Why did I do it? Because physicians could build for it. What we now know, nurse practitioners, physicians, assistants can often do it better and cheaper and, and more routine tasks. And so by, and one of the advantage we have in Rutgers Health is all of those schools are under, us, us under one roof. So if we need more practitioners, nurse practitioners, we train them. If we need more PAs, we train them. And, and as the world moves to more population health, going forward, and we move away from feed for service, accordingly, because, you know, we, we're bankrupting the country and healthcare and yet don't have good outcomes. One of one of the solutions is we need to think more population based. And, and we need to make better use of other professionals who can actually do a better and cheaper job of it and save the physicians with the most expensive than the things that you really need the physicians time for. And, and, and I'm, you know, it's, I, I need your health has sort of done this using more time from psychologists and social workers and saving the physicians to write the prescriptions on, and in which case, it's not as satisfying to the physicians that they don't have the relationships with the, with the patients. But, you know, there's no one silver bullet here, but I think we've become two, healthcare has become too much with a big corporate entity focusing on our health. It's really to come sick care, not healthcare. It's really been been, you know, people do bad behavior, they get sick, they come in, they treat it for the sickness, they sent back out where they do the bad behavior again, whether it's smoking or drinking or whatever it is that they're doing too much of, you're not focusing on keeping people healthy and focusing on, on, on only treating them when they're, when they're sick. And that's because the current incentive system, that's what it pays, you know, the, the, and, and that's what is changing as we move to more to population now is, is, is, and because, you know, we're bankrupting the country, we're approaching 20% of the growth national product. And yet we have bad outcomes. The countries that spend half as much as we have, have better local outcomes than we do because we focus, you know, we don't need as many MRI machines, we don't need as many CP skinings, we don't need as much surgery, we don't need as much testing, we need people to think more, but, but our, the healthcare system, classically, doesn't pay people to think it pays people to do it. Surgeons are paid a lot, harm a carelox of paid much more, pediatricians, neurologists, and psychiatrists, roll paid much less than surgeons or, or, or, other higher paid, special paid. And, and we, we're, we're in this cycle where, where, if you want to maintain salaries, income, we need them to spend spending all the time in the operating room and spending less time with patients going forward. So, so it's not one solution. I think the, the closest to one solution is really population out that's really sort of moving to a, a, a, uh, probation per month basis for reimbursement, with the, where, uh, suddenly the risk of the providers, um, it, you know, instead of being paid to do too much, you're, you're taking the risk of patient gets sick. Yeah, I understand. So now the incentives are aligned. Now the incentives are aligned. Yeah. But now the incentives are aligned in the wrong direction. Now the incentives are aligned to do too little. Mm. If you, if you pay, if you pay per month, it also changes the character because an individual docs can't, uh, or even individual hospital, can't possibly afford that one transplant patient would bankrupt you. So the hot, the docs come together, the hospitals come together, everything is, is, is all coming together. And that's what happening. What is happening? And, and healthcare is the consolidation. Uh, accordingly, in order to deal with that, you also, in order to prevent under treatment, you need a huge data infrastructure. You need to be able to say that as everyone has gotten that COVID vaccine, gotten their COVID vaccine, as everyone has gotten, they, who has a high blood pressure, are they getting treated, treated at the high cholesterol that being treated? You need a huge data infrastructure to do that. And again, that requires a, a mass, a scale to be able to put that together and, and, and, and afford, uh, to do that. And, and so what you're saying, seeing, of course, the country is, is this enormous consolidation, as we move, um, we're in this funny in between now, moving from a fee for service system to a population system. And, and the health systems aren't, have a very hard time. Different speeds in different localities. If you move too slowly, you'll go bankrupt. If you move too fast, you'll go bankrupt, because right now in many places when the embarrassment is still primarily fee for service. So if you move too much toward prevention, we go, but yeah, we keep people out of a hospital. The hospitals go make up. Um, but we don't need anywhere near the number of hospitals we have. If we actually focused on keeping people healthy, right, rather than, than waiting for them to get sick and treating them and they get sick. So low, twisted incentive system. Thanks for tuning in. If you found this valuable, don't forget to hit that subscribe button so you never miss an episode. And if you want to dive deeper into this conversation, check out the links in the description to watch the full episode. See you in the next one.