Most of what you describe is relevant here in Canada, too, even though some of the payment/profit motives do not apply. Managerialism is forcing many of us to the verge of burnout and early retirement. Doctors (and nurses) are leaving the profession or choosing to work less. The government keeps coming up with "solutions" which only create more problems in the long run, the result being that our healthcare system is crumbling. In many communities, we can't keep emergency rooms open--and even when we do, wait times are often 16-20 hours. People are literally dying at home because they can't stand the thought of sitting in a hard chair in a crowded waiting room full of miserable, sick people for that long. Our "free" (but actually very expensive) healthcare has left us all equally miserable in the rubble (with the exception the very rich, who can fly down to the Mayo Clinic for treatment whenever they like.)
Chris actually wrote a whole Substack about the overmanagement problem in Canadian healthcare a few months ago, although your Sub really adds to our conceptualization of the underlying philosophical drivers of it: https://pairodocs.substack.com/p/managed-to-death
Thank you, Dr. Kheriaty, for this fine paper that explains what is happening in medicine today. As a retired RN, I remember the days of individulized medicine, where physicians knew their patients and skewed their treatment to match that particular person’s needs. In those days we had general practitioners or internists who were the gatekeepers of healthcare for their patients. When a patient’s condition required a physician with specialized training, that person was brought in to consult. Today the general practitioner or internist is being greatly replaced with PA’s and nurse practitioners and everyone goes to a specialist for nearly everything. That leaves the patient with no one who really knows him/her or one who coordinates their care. You are exactly right in stating we need a parallel medical intervention that is, I believe, much like what the FLCCC or the Wellness Company is offering. I would hope that we also see a movement that brings in more physicians with fundamental more holistic methods of treatment. The payment for these services is the problem right now because most people pay high premiums for health insurance. I pray we can overcome these obstacles and get back to the patient-centered care in which I was trained.
These flaws affect dental medicine too. Let's not ignore the fact that so many of the newer practitioners leave school with insane amounts of debt. Then reality hits with how the medical system is dysfunctional for the patients and healthcare providers, but immensely profitable for Big Pharma which has no financial interest in dealing with metabolic systems. Big Pharma has no objections to people being on multiple "medications" for life while getting sicker.
This is a great post, and a a physician, i especially relate to what you have said. I was involved in the "collaborative" Physician-Hospital Organization, that was organized by tying physician compensation to these so called evidence based guidelines. I thought I was doing a good thing with this, and couldn't figure out why it was so tough to get the docs to go along. After all, we all want to maximize population health, right? Now, after COVID, I realize that Population health means things like getting every living being vsccinated, need it or not. No thought required. No one my colleagues were unhappy. And yet... they all went along with the mass vaccination campaign! An effective Psyop, that.
With regard to the thesis that managerialism can be blamed for this sorry state, I refer your readers to The Total State by Auron MacIntyre. It's a whole of society problem!
OT, but I utilize the (excellent) video Aaron features in the cross-posted interview with Jay Battacharya, in my recent piece, a piece which helpfully distinguishes a.) censorship-by-def.-of-the-1st, and b.) suppression. While we loosely use both terms at times, in my writing, "suppression" is the not-violative of the constitutional letter choice of journalists, pundits, outlets, and politicians, to not talk about a major story, for the sake of killing it. My piece is titled "The Purpose of Open Journalism" Francis Canavan, the US Supreme Court, and the Present Crises of Censorship and Suppression." https://pomocon.substack.com/p/the-purpose-of-open-journalism-and And if you want a separate link to Aaron's video, here ya go: https://www.youtube.com/watch?v=ZLcNUiANRIo
Edwin Leap just published this graph on his excellent Substack showing the remarkable population growth among healthcare bureaucrats in comparison to numbers of physicians.
This is a great article, Dr. Kheriaty. The ideals that should guide physicians are the Pillars of Medical Ethics. In my academic days I taught my medical students the 4 pillars on their first day of service to use as a map on how to prevent harm to patients. They are intended to keep us grounded to the Oslerian practice of medicine, but I fear the pillars have been forgotten, ignored, or even misused in recent years. Our patients are the ones who will suffer their loss.
Most of what you describe is relevant here in Canada, too, even though some of the payment/profit motives do not apply. Managerialism is forcing many of us to the verge of burnout and early retirement. Doctors (and nurses) are leaving the profession or choosing to work less. The government keeps coming up with "solutions" which only create more problems in the long run, the result being that our healthcare system is crumbling. In many communities, we can't keep emergency rooms open--and even when we do, wait times are often 16-20 hours. People are literally dying at home because they can't stand the thought of sitting in a hard chair in a crowded waiting room full of miserable, sick people for that long. Our "free" (but actually very expensive) healthcare has left us all equally miserable in the rubble (with the exception the very rich, who can fly down to the Mayo Clinic for treatment whenever they like.)
Chris actually wrote a whole Substack about the overmanagement problem in Canadian healthcare a few months ago, although your Sub really adds to our conceptualization of the underlying philosophical drivers of it: https://pairodocs.substack.com/p/managed-to-death
Thank you, Dr. Kheriaty, for this fine paper that explains what is happening in medicine today. As a retired RN, I remember the days of individulized medicine, where physicians knew their patients and skewed their treatment to match that particular person’s needs. In those days we had general practitioners or internists who were the gatekeepers of healthcare for their patients. When a patient’s condition required a physician with specialized training, that person was brought in to consult. Today the general practitioner or internist is being greatly replaced with PA’s and nurse practitioners and everyone goes to a specialist for nearly everything. That leaves the patient with no one who really knows him/her or one who coordinates their care. You are exactly right in stating we need a parallel medical intervention that is, I believe, much like what the FLCCC or the Wellness Company is offering. I would hope that we also see a movement that brings in more physicians with fundamental more holistic methods of treatment. The payment for these services is the problem right now because most people pay high premiums for health insurance. I pray we can overcome these obstacles and get back to the patient-centered care in which I was trained.
I agree completely!
These flaws affect dental medicine too. Let's not ignore the fact that so many of the newer practitioners leave school with insane amounts of debt. Then reality hits with how the medical system is dysfunctional for the patients and healthcare providers, but immensely profitable for Big Pharma which has no financial interest in dealing with metabolic systems. Big Pharma has no objections to people being on multiple "medications" for life while getting sicker.
Correct, in fact, Pharma profits precisely when we are sicker, not when we get well.
This is a great post, and a a physician, i especially relate to what you have said. I was involved in the "collaborative" Physician-Hospital Organization, that was organized by tying physician compensation to these so called evidence based guidelines. I thought I was doing a good thing with this, and couldn't figure out why it was so tough to get the docs to go along. After all, we all want to maximize population health, right? Now, after COVID, I realize that Population health means things like getting every living being vsccinated, need it or not. No thought required. No one my colleagues were unhappy. And yet... they all went along with the mass vaccination campaign! An effective Psyop, that.
With regard to the thesis that managerialism can be blamed for this sorry state, I refer your readers to The Total State by Auron MacIntyre. It's a whole of society problem!
Chilling, but very informative. Thank you!
OT, but I utilize the (excellent) video Aaron features in the cross-posted interview with Jay Battacharya, in my recent piece, a piece which helpfully distinguishes a.) censorship-by-def.-of-the-1st, and b.) suppression. While we loosely use both terms at times, in my writing, "suppression" is the not-violative of the constitutional letter choice of journalists, pundits, outlets, and politicians, to not talk about a major story, for the sake of killing it. My piece is titled "The Purpose of Open Journalism" Francis Canavan, the US Supreme Court, and the Present Crises of Censorship and Suppression." https://pomocon.substack.com/p/the-purpose-of-open-journalism-and And if you want a separate link to Aaron's video, here ya go: https://www.youtube.com/watch?v=ZLcNUiANRIo
Edwin Leap just published this graph on his excellent Substack showing the remarkable population growth among healthcare bureaucrats in comparison to numbers of physicians.
https://substack.com/redirect/33ae682f-3de2-4fdc-b351-f6b4b9a1bfb7?j=eyJ1IjoiejBkY3oifQ.kfptX5-LbotTQBpnv9Y2Ben-cGOhjb1SStykPq1YSpI
Outstanding article.
This is a great article, Dr. Kheriaty. The ideals that should guide physicians are the Pillars of Medical Ethics. In my academic days I taught my medical students the 4 pillars on their first day of service to use as a map on how to prevent harm to patients. They are intended to keep us grounded to the Oslerian practice of medicine, but I fear the pillars have been forgotten, ignored, or even misused in recent years. Our patients are the ones who will suffer their loss.
Found a typo "biomedical technology can be used for all kids of other pursuits"
Was unaware of these issues.