Latest / Success Story with Scott Clary / Lessons - Why Public Confidence in Healthcare Is Declining | Brian L. Strom - Medical Ethics Expert

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Lessons - Why Public Confidence in Healthcare Is Declining | Brian L. Strom - Medical Ethics Expert · Success Story with Scott Clary

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