Why we should question state board licensing of physicians
Our nation's healthcare system is broken, and that indisputable acknowledgement is a national disgrace. Furthermore, every governmental and professional entity that has taken part in establishing the current, deplorable state of unorganized dysfunction shares in that enormous blame. I've outlined "5 great mistakes," to merely serve as a device to use in an effort to convey the extent of colossal failure(s) that have accumulated through the years leading to the current social contradiction. The order of presentation is not indicative of their degree of contribution, but the sum of their totality is indicative of the ineptness of those who through the decades have sought to create one of the most important aspects of every civilized nation, while failing to first create a creditable master plan.
1. The "system" is not a system
One of the greatest fundamental failings in any large endeavor is the constant misuse of descriptive terms necessary in every form of discourse regarding that endeavor. And the constant use of the word "system" in relation to the current healthcare apparatus is glaringly misleading. A system is defined as an assemblage or combination of things or parts forming a complex or unitary whole. Every person who enters the current healthcare "system" does so by utilizing multiple anatomical "systems." Close examination of the current so-called healthcare system will demonstrate that each separate component functions as though each speak a different language.
The current quality of healthcare is clearly demonstrated by the fact that every new estimate of needless hospital deaths has been significantly greater than all previous estimates — for the past quarter century. Yet this deplorable track record has received less national attention than periodic episodes of sporadic acts of violence.
2. The difference between healthcare" and "medical care"
Healthcare is initiated by medical care. Yet anyone attempting to read and hope to understand the efforts to "improve healthcare" is left to believe that healthcare is statistics derived from data concerning the cost of care throughout that system. Cost, as with every other aspect of attempting to provide medical care to individuals, is important. But one should not attempt to improve the quality of a product by merely controlling the cost of that product. Quality improvement in medical care must come at the physician/patient interface.
3. State responsibility for the healthcare delivery system
All medical care is local, and states license doctors. Those two irrefutable facts have been consistently ignored as to their collective importance. In addition, each state's medical examining board is over 100 years old, and each of those boards' mission statements contains the phrase "to regulate the practice of medicine."
Each state created a medical examining board long before anyone ever imagined that the nation's healthcare system might require some semblance of an organizational structure, and each state's responsibility for such was clearly evident. Furthermore, each state had created a second agency for the "regulatory control of hospitals" long before the enactment of Medicare and Medicaid. Unfortunately, no state governor or legislature has every recognized their importance in the larger scheme of the nation's healthcare system.
Many of those actively seeking to improve the quality of healthcare and patient safety appear to strongly favor a federally controlled healthcare delivery system.
However, the federal government, and its multiple healthcare agencies, have compounded each state's original mistake for the past half-century. Simply combining state-board medical board efforts across the nation isn't a viable solution to healthcare's problems, unfortunately. The current VA system is clear evidence of how poorly centrally controlled systems "function."
4. The hostility between the major healthcare components
Physicians controlled the delivery of healthcare throughout the majority of the entire history of our nation and sadly turned their profession into a 'Good Ole Boys Club.' Every state medical examining board has been a regulatory agency in name only.
States recognized the need to "regulate" physicians and hospitals, but failed to ensure that the regulatory agencies they each created were suppose to function in an effective
manner.
More significant, though, is that each of the major components necessary in a truly functional healthcare delivery system — states, the federal government and physicians — treat the other components as inferior considerations.
A healthcare delivery system worthy of that name can only become reality if, and when, each of the major components recognize that all three must join together with mutual respect, and combine their efforts for the good of the nation.
5. The medical profession's reliance on civil litigation for accountability
Every call for more medical malpractice tort reform is another promise suggests to patients that physicians don't want to be held accountable for their mistakes. Yet, many patients have no other recourse to hold physicians accountable than through the courts. Hospital medical staffs have been dominated by their members' "Code of Silence," and that failure to put the rights of their patients first has led to many patients taking to the courts to ensure they are compensated for errors, and that the same errors don't happen to other patients.
The Solution
The two most important characteristics of the current healthcare delivery system's problems are: it is broken, and no one seeking to improve it can first describe, in detail, its present structure. A solution must begin with a definitive understanding of the current entity to be changed by identifying every contributor, and their contribution to the current dysfunction. Such an exercise would rapidly illustrate each state's responsibility to be included in any effort of creating a modern-day patient-care system.
But no progress can be anticipated unless the three major components, federal, state and physicians, are able to come to the table in a respectful manner, and begin to truly serve the public. One of the greatest follies of every civilized nation is how little fundamental thought and understanding each of those nations has given, or failed to give, in the construction of one of their most important elements, the delivery of healthcare, and how such consistent and long-standing failures have been so unrecognized, and unreported.
"The health care system is broken!" That irrefutable national disgrace has been passively accepted, rather then igniting a pubic firestorm. The public deserves far better.|
Ira Williams, DDS, is a a board-certified oral surgeon, a former United States Air Force Res. Major and author of "Find the Black Box: Prevent Needless Hospital Deaths."