"... it can take a few paths. It can aim for restoration—bringing back the empire—which in this case would probably focus on gatekeeping. It can retreat, which might mean abdicating medicine’s broad public role, perhaps in favor of a narrow focus on earnings and technical skills. The last—and, in my view, the best—path is reinvention. Doctors can remake their profession by embracing the multi-polar medical landscape they now inhabit, and by acting as a kind of system stabilizer: working with other powers to help shape rules, norms, and relationships. A superpower may act as though it can stand alone, but middle powers know the value of diplomacy and coalition-building. Reinventing the medical profession will require greater engagement with the world outside of hospitals and clinics. Many physicians are taking to social media.... A growing number of doctors seem interested in leading health-care companies themselves or in running for office.... Diplomacy also requires a willingness to stand in opposition to others.... A few weeks ago, a dozen former F.D.A. officials, all of them physicians, wrote that they were 'deeply concerned' about 'the latest in a series of troubling changes'...."
Writes Dhruv Khullar, in "The Role of Doctors Is Changing Forever/Some patients don’t trust us. Others say they don’t need us. It’s time for us to think of ourselves not as the high priests of health care but as what we have always been: healers" (The New Yorker).
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63 comments:
Sounds to me like they’re giving themselves permission to politicize healthcare at the level of patient care.
No ‘let’s work to improve the quality of the experience to rebuild the trust we’ve lost’ and all ‘Let’s figure out how to make the fuckers do what we tell them…’
"Some patients don't trust us."
My mother said that while doctors shoulder seniority, nurses run the medical profession, doubly so with the increase in nurse practioners.
The dancing covid nurses didn't help...
Maybe they could try being medical doctors instead of philosophical doctors.
China and Russia and India and Mexico are better places to go for Health Care than most hospitals in the US.
When a hegemon loses power, don't they become warlords?
Let's have less tyranny, and better information so we can make our own decisions.
I remember when some doctors "stood in opposition" to some of the more draconian COVID "guidelines" and I remember where that got them.
Obamacare turned US Healthcare into a giant sucking slush fund for corporations and insurance companies.
Mitt Romney and Barrack Obama should burn in hell forever for devising this system and foisting it on the country.
Gruber sold him the magic beans
The entire medical profession pretty much destroyed its reputation and ruined its relationship with the public during the COVID19 pandemic. They completely fell in with and supported the left-wing ideology rather than sound medical practices. Face coverings outdoors, 6-ft social distancing, forbidden medicines, dancing nurses, Dr. Scarf dictates, completely fraudulent cause-of-death statistics, etc., etc.
I was forced to go to local ER with my elderly father recently. In a supposedly good hospital in a wealthy area, the care was appalling. We were there for 10 hours total. In hour 2, the doctor ordered that a urine sample to rule out a UTI. By hour 9, that had not yet been done, and when the doctor came back in, he was astounded at that failure. The whole time I could view the nurse's station from the room, and there were aways several nurses sitting at the desk there scrolling pictures on their phones. I had to keep walking to the desk and asking for things like a blanket, because it was cold and he only had a thin hospital gown on. Or a drink of water, because we had been there for hours -- and they were supposed to get a urine sample. There were gaps of more than an hour between anyone even poking a head in to see how he was.
Guy could use some AI editing assistance. That's some serious word salad.
Yes we lost trust. That happens when medical professionals ignore their oath and every bit of epidemiology training to "go along" with fascist government orders to get a shot. The few brave men and women who bucked that trend should be revered as heroes. Thank God they (the brave) are well represented at HHS now and actually following the science instead of using that as a slogan to kill people.
Many family practice doctors have become digital technology technicians, glued to their computer screens, asking questions prompted by computer program, plugging in the answers to fill a matrix questionnaire. Out pops the "answer", a diagnosis. Or not. Oh well, that's what BCBS health insurance wants - easy answers, quick appointment, straightforward copayment charge for captive customer.
Our Northwestern University-affiliated GP, member of its large medical practice of physicians, had a FT personal assistant assigned to him, a "time-management person" to keep him within the allocated 12 minute patient appointment slots. For last five years, GP didn't touch us during our exams, only quizzed us via laptop program questions. GP finally quit Northwestern faculty foundation medical practice, to join a posh concierge medical practice, which charges $7500/year simply for privilege of booking medical appointments, on top of BCBS insurance premiums and copays and out-of-pocket charges.
GPs are now the auto mechanics of medical complex industry, selling Big Pharma drugs and routine medical tests for their corporate employers.
Maybe doctors should refrain from describing their profession like Metternich did the European powers?
I was wondering yesterday why I need my family doctor at all. We’ve started using urgent care more recently because we can get an appointment sooner and they have equipment there where we can get tests run and sometimes get immediate treatment. My family doctor pretty much just refers us to someone else.
I read that twice and I still have no idea what the fuck he is talking about.
Youre not supposed to
'We're not trusted as we once were. To fix that, we should spend more time on politics and social media.'
I'm sure the whole piece offers more nuance, but that's the highlight of this wordy excerpt.
Is this mother fucker related to Kamala Harris? He shares her incredible ability to express complex thoughts.
I do believe he's onto something. Also- docs are burning out quicker. I've seen it in my own family. They enter wanting to be healers. They end up following edicts from large medical corporations and staring into their computers all day as it follows them around on their rounds. Some spend their efforts at getting published, not so much healers as self-promoters.
There has to be better ways of doing what we're doing. Personally, I love my functional medicine doc. She's brilliant. Perhaps the best doctor I've ever had. But I do also have a primary care doc who I use, not as a comparison, but as a complementary doc. My choice of course. But I love both my docs. It took me 5 tries in my current city to find a doc I loved working with. The functional medicine doc I've used for years and works with me from another city.
Health insurance doesn’t make sense to me. Insurance should cover unexpected catastrophic costs. Insurance shouldn’t cover expected nominal costs - like annual check ups and routine tests because then it is just prepaying for services and paying for a useless middleman in the form of the insurance company. Medical malpractice insurance is also out of control but that is caused by asshole tort lawyers and the awarding of excessive monetary claims.
We need more doctors but expanding medical school enrollments won't help. There are not enough residency programs and clinical training sites for students to complete their requirements to become medical doctors.
Some patients don’t trust us.
In 2020 hey nonchalantly threw away the reason why people trusted them. What did they expect?
Doctors used to subsidize the poor by overcharging the rich. "Presentation of the Bill" was the tough course in medical school, the bill being the bill to the rich. That was before bureaucracy, requirements, paperwork and penalties made it impossible. Also those doctors all left the profession with Obamacare.
My daughter was extremely sick with a URI a few years ago over Christmas. My family doctor wouldn’t see her because she wasn’t a current patient. So we took her to an Urgent Care nearby run by a large hospital chain. She got an appointment for that same day.
This was during the Covid panic. A couple of things impressed me.
1. They didn’t give her a Covid test. Instead the gave her a chest X-ray on site and evaluated it immediately. Her lungs were clear. That being the case it did matter if it was Covid or regular old flu. They gave her the regular bed rest, fluids, Tylenol instructions, and told her to pick up some OTC products to clear up her symptoms. Check back with her doctor in a few days if things didn’t improve.
2. OK, I guess it was one thing + the fact that they saw her almost immediately.
“Some patients don’t trust us.”
No kidding. When I had mild Covid, I asked my GP for
Ivermectin. He refused, saying it was toxic to the body. Huh? I found another GP. The first idiot doctor retired shortly after that.
The medical profession has no one to blame but themselves.
My various docs are great - but we lose our health insurance in about six weeks and are still exploring what we want to do about that.
The two things I wish were different in our system are, first, health insurance (it should follow the person, not the job, and it should be serious-to-catastrophic, not routine maintenance, so to speak), and medical records: I think this latter thing is getting better, but I still have a hard time figuring out which patient portal to visit to find out, well, pretty much anything. So I'm not asking for much ... just an overhaul of our entire system, I guess.
Lawnerd said... 12/19/25, 8:48 AM
Yes to all.
I'm old enough to remember that, in my childhood, customary and expected medical/dental care expenses were paid out of pocket, and were (as I recall, though I may be wrong on this) a federal itemized tax deduction with no minimum amount to qualify. ...while insurance covered unanticipated care and hospitalization expenses.
It was even called "major medical" insurance, IIRC.
Even the HSAs of recent memory, with insurance coverage of unanticipated and "catastrophic" events, mimicked that strategy, and were logical and effectively met the typical person's needs.
Obamacare was poorly designed, and thus ripe for fraud and abuse & impossible to fully financially support, from the git-go.
Oh and, by and large, medicine has ceased to be a "profession," and has become a "business" (if not a "racket," per the quote often attributed to Eric Hoffer.)
Most doctors aren't "healers," just highly paid employees of large healthcare systems. They also maintain a DEI cartel.
When you're at the bottom of a hierarchical monopoly, you treat the customers like they're even lower than you. The DMV. Lawyers. And yes, doctors. OTOH, if your hierarchical institution has competition, you treat the customer like he's the boss. Department stores (before they all got eaten by Macys, anyway). Church denominations (even the RC priests are mostly happy-clappy now).
Doctors (and lawyers) haven't figured out "yes, it sucked being talked to like an idiot for half my career, but if I treat the guy in front of me that way, he's not coming back." CC, JSM
I treat doctors as advisors for the most part. They are quite fallible. I once had pain in an elbow and went to a sports med physician who examined me for a couple minutes and pronounced that I had tennis elbow.
I did not have tennis elbow. I knew that. The pain was in the wrong place for the wrong movement for tennis elbow. But, "He's the expert" I thought, and went ahead with 6 weeks of PT for tennis elbow. Accomplished absolutely nothing. FInally, I figured out exactly which movement was making it hurt and where (at the gym), looked over the muscle chart poster and determined it was part of the biceps (brachialis), checked Schwarzenegger's encyclopedia of bodybuilding to see which exercise strengthened that, and the pain went away (that was a strategy I'd gleaned earlier).
MD's have expertise but it's not unlimited and can't be wholly implemented by following an algorithm. I mean, that's why it was called 'practicing' medicine.
Friends of mine, a married couple who were both nurses, told me about a doctor they'd worked with, a dangerous incompetent whose real name I won't use, but it was something like Amad Hussarri. The other doctors and nurses called him OhGod ImSorry.
Now watch. Somebody will say that I and my nurse friends are racists. And that kind of thinking is one of the reasons the medical profession and so many other institutions are messed up today.
MDs used to be business people, managing a practice and developing strong familiarity with their patients. In the late 1980's, hospital systems started buying up private medical practices. Hence, MDs started reporting to corporate drones with MBAs and MPH degrees.
Obama care accelerated that trend and put insurance companies in almost complete control of health care.
Does anyone think that has been a good thing?
@ Anthony
This guy has a really sore arm so he goes to his doctor. The doctor says, I need a urine sample.
The guy says, but it's my arm...
The doctor says, We have a new machine, miraculous really, it can tell anything that's wrong with you just from a urine sample.
So the guy grumbles, but provides one.
The doctor dumps it into the machine and hits the start button. The machine bleeps and bloops for a minute then, brrrrrrrr brrrrrrr brrt, it prints a out a sheet. The doctor tears it off, reads it and says, You have tennis elbow.
The guy scoffs and says, I don't even play tennis.
The doctor says, The machine is never wrong, gives him some pills and instructions for taking it easy on his arm and tells him to come in for a follow up in a week.
The guy goes home disgusted and completely skeptical. When the day of the next appointment rolls around, he thinks to himself, I'm going to mess with this doctor and his damn machine.
So he gets a urine sample from his wife and one from his daughter. Then gets some oil off the floor of his garage. He mixes it all together, then for good measure, he jerks off into the sample as well.
When he gets to his appointment, he hands the container to the doctor. The doctor dumps it into the machine. The machine bleeps and bloops for a long time. Finally, brrrrr....brrrrr.... brrrrr....brrrrrr...brrt. The doctor tears off the result sheet and says,
Your daughter is pregnant, your wife is sleeping with everybody in town, your Volvo needs a tune-up and if you don't quit jerking off, you're never going to get rid of that tennis elbow.
The lost in trust wasn't just due to COVID policies. When an entire profession tells you men can be women and women can be men, there is no way deep down anyone is going to trust them; even those who outwardly nod their heads in agreement.
The "change" that these guys are most "deeply disturbed about" is that they are "former F.D.A. officials". They spent their whole careers feathering their nests, only to discover that their nests could be taken away from them.
Heh.
Must. . .not. . .start telling. . . .doctor jokes. . . .
There is tennis elbow and golfers elbow. An ortho expert witness once told me that in his experience golfers generally get tennis elbow and tennis players get golfers elbow.
Bob Boyd it is my understanding that the major risk involved in this guy's situation is carpal tunnel syndrome.
Just one...a small one. "It's only wafer thin..."
The all-important doctor/patient relationship is dead. If a person needs medical care, many relationships affect the care received. Government, Big Pharma, Cultural Pressure, Economics, Legal, Professional Associations, etc., all have a say in patient care. Look no further than responses to Covid.
Once a protocol has been established, that's what the patient gets.
If all the boxes are checked, the deceaased received everything the situation called for; too bad he died. Good luck winning a judgement of malpractice.
If the patient refused "proper" preventative measures or treatment and either didn't become ill or survived... too bad he lost his job, insurance, good name.
AND, don't fool yourself - the Sainted Nurses are in on the charade. At the peak of the "crisis" I was admitted to hospital with pneumonia (caused, at least in part, I think, by wearing a stupid mask and re-breathing too much polluted air). I was tested for Covid over a dozen times in multiple ways. All negative. Admission records state "Suspected Covid". Ka-Ching $$$$. Naturally I was isolated with other "Covid" patients and treated as if I had it. Mention of words like "Ivermectin" caused great alarm and affirmation that I was a fucking moron (thank God for contraband).
I know enough about medicine to know that treatment was doing nothing to combat pneumonia. When I realized all my medications (I am on life-sustaining drugs for liver problems) had been changed "automatically" by some computer program, I rebelled.
The head nurse took over my "care" from a previously cooperative nurse, I ended up threatening her with physical violence if she touched me. She threatened to call in the hospital goon squad and put me on a respirator. I said, call your lawyer; somebody's gonna get hurt. Never saw her again. I continued to manage my own care for two days until i was able to do without supplemental oxygen, altogether. A pumonary doctor agreed to release me if I would sign a waiver. I refused. Told him to have someone take out the tubes or I would do it myself. Got dressed, called a ride and left. So weak I could barely get in the car. Did not care if I died as long as it was with friends and family and not the ASSHOLE Protocol Robots in the hospital.
The nice nurses and therapists that were sent to my home told me that if I did what they said, I had a good chance of full recovery within 10-12months (with the caveat of "full" recovery being about 80 percent of what I was before getting sick).
I was scolded for "doing it my way" which included pushing the envelope and a teensy bit more, constantly. Day one, I "walked" to the mailbox at the end of the driveway with a walker and help of my son. In a month, I was still using the walker (some vertigo issues) but I was doing four miles a day at nearly 4 MPH. The home care people stopped coming after about six weeks. Still hiking the alps Sep/Oct every year.
Inform yourself. Don't be afraid to politely challenge your doctor/nurse/PA. Even the good ones are constrained by myriad shackles. If you can, stay the fuck out of hospitals!
As a footnote, I wonder how many of those hundreds of thousands of opiate deaths have been caused by the government/legal/professional war on drugs that drives people in chronic pain to seek relief outside "the system".
I just had a very skilled doctor perform a laminectomy (I didn't know what that was until he explained it) on my spine. There was a complication, and I ended up spending three nights in the hospital, having two operations and, at one point, experiencing more pain than I've ever felt before.
As I said the doctor was very skilled, yet he couldn't have foreseen this problem. He solved it, and I am back home healing.
What impressed me was that he he was so good that he was constantly engaged with one procedure and patient after another. He had an entire platoon of residents, PAs, and nurses supporting him. It was clear that HE was the money maker, and the benefits to the organization flowed downhill from his knowledge and efforts.
A very efficient machine.
I trust that guy. He's a nerdy genius.
What a bunch of crybabies. Your health is your own responsibility. People treat their bodies like driving their car for years and years without ever checking the oil or the radiator fluid and then blame the mechanic when the car has to go to the junkyard to be crushed.
12/19/25, 10:07 AM
The make-or-break courses for pre-meds are physics and chemistry, especially organic chemistry. And they study very hard, because they need the grades to get into med school. But the physics and chemistry majors regard them as also-rans. They are, almost to a man (nowadays, mostly women), completely uninterested in understanding the subjects they must study. They want to know the answer. They're bright, but very few of them are independent thinkers.
But I suppose, if "A growing number of doctors seem interested in leading health-care companies themselves or in running for office..", it makes sense that they would not waste their time on scientific knowledge, when all they are really after is a credential conferring social and economic status.
Your health is your own responsibility. People treat their bodies like driving their car for years and years without ever checking the oil or the radiator fluid and then blame the mechanic when the car has to go to the junkyard to be crushed.
Good Lord! I agree with Howard.
That happens once or twice a year.
We can peer through the farthest reaches of the universe via telescopes and we landed a man on the moon a century ago. But we are still guessing the true condition of the sick right here in front of doctors medicine man and quacks alike.
It’s as if big pharmaceutical, big insurance and the hospitals triad are the least interested in people getting well.
"Doctors diagnose. Nurses heal." -- Nurse Jackie
But of course, she had a vested interest in saying that.
Bob Boyd that was hilarious 👆🏽
Howard said...
What a bunch of crybabies. Your health is your own responsibility. People treat their bodies like driving their car for years and years without ever checking the oil or the radiator fluid and then blame the mechanic when the car has to go to the junkyard to be crushed.
1. I am forced to pay for it this system. I have to pay for a system I don’t even use and I have to spend additional money to pay for the services I actually need.
2. When my father had his accident and was flown to harborview they strapped him to a bed and locked him in a dark room for 2 and a half days and wouldn’t let my brother or mother visit him because of “COVID” regulations. He had a head injury and was not fully rational.
Our health care system is populated by absolute evil.
Lem: the solutions to most of the chronic medical issues people deal with today are widely available via peer-reviewed research readily available on the internet via your favorite AI savant
I had the exact opposite experience, Achilles. I had a hemorrhagic stroke that look out my left leg hip flexors and the entire lower leg in November of 2020. Pretty much peak covid Hysteria. I was allowed to have visitors in the hospital. I got all of the care that I needed, including multiple CT scans MRI and a cranial angiogram. The nurses on the stroke ward were angels. The rehab PT was an excellent coach that help make it out of there after a couple days of hard work. All of it covered by my insurance less a $500 deductible.
I think the lawyers at The New Yorker must have helped him write that first paragraph.
He seems to, but does not actually, blame a hormone supplement for the potentially fatal blood clot but won't name that supplement, which would be nice to know assuming there is any real connection between it and the clot.
Seems like the doctor knows best, or thinks he does.
Also, if you Google the author and then click on his New Yorker author profile you'll see that they OJ'ed him. Funny.
"Many family practice doctors have become digital technology technicians, glued to their computer screens"
At my annual checkup last week the doctor had someone listening in remotely to transcribe the conversation so the doctor wouldn't have to stare at the screen and enter data the whole time. I don't know if the remote person was in India or a speech to text program, but I thought it was an interesting approach.
I know a lot of great doctors, both personally and professionally. What makes them great is their focus on their patients and their patients’ medical problems, which they treat with deep knowledge, compassion and medical judgment. Cosplaying a politician or policy activist isn’t part of the toolkit.
Pregnancy is not an illness. Puberty is not an illness. The medical profession needs to stop prostituting its skills for money. Full stop.
Bruv was one of the cdc validator
Howard said...
I had the exact opposite experience, Achilles.
I am so happy for you.
About a year or so later one of the several hospitals called my mother and tricked her into emptying her savings account to pay a bill for my fathers care. A bit over 5000 dollars.
But I am glad you had a good experience with these evil shit weasels.
Every hospital experience has been fantastic. Double hip replacement, sinus polypectomy twice, hernia surgery, two heart ablation procedures, emergency hernia surgery and a stroke.
If you are constantly dealing with "evil" people, maybe it's you and not the world.
“Sounds to me like they’re giving themselves permission to politicize healthcare at the level of patient care.”
Weel that rehajam feller said a pre-tty clever thing there. The onus is on the physician to cure, defined in the Hypo oath and such. But health care in Canada and Uk has been a matter of, can you go to the US or somewhere else to get care that is not going to be too late.
Canada follows the UK, and the UK follows dingy town socialism.
I have had a lot of surgeries, some very substantial. The serious stuff is handled very well. It's the routine things that are terrible. Charges for routine visits and minor procedures are just gouging.
The problem doctors face is that they are no longer gatekeepers for the information. I can get much better access to better information on my own. They still try to maintain the paid gatekeeper role for prescriptions and procedures, but that's starting to slip because of the cost. I pay for and order most of my own blood tests, and you can often pay for your own scans at lower cost than through insurance. Other than surgeons, most doctors have a vastly diminished role in actual healthcare. The technology is wonderful, but the whole bureaucratic system is a mess.
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