Book Review: A doctor bears witness to America’s healthcare dysfunction

One doctor, one patient — this is the basic principle taught in medical school to protect against any interference that impedes a doctor’s ability to maintain an empathetic and productive relationship with their patient. But insurance companies, governments, and corporations have wedged themselves between the two, fighting a war for financial and political gain that’s weakening the doctor-patient relationship and forcing doctors to surrender to algorithms and codes.

In his recently-published book, The People’s Hospital, Dr. Ricardo Nuila relies on his own experiences as a physician to answer the question, “Why is America’s healthcare system so dysfunctional?” The book bears witness to the toll the system places on patients, families, caregivers, and our society at large. To crystalize his thesis: over the course of the 20th century, through a confluence of events — from the original concept of insurance to the introduction of employer-sponsored insurance to the passing of Medicaid and Medicare to the corporatization of medicine — the practice of medicine has devolved into the business of medicine. As a result, byzantine procedures not only influence a doctor’s decision-making criteria but ultimately determine it. Because today’s clinicians are forced to negotiate the quality of care rather than maintain its quality, they are experiencing a loss of control while grappling daily with life and death moral dilemmas.

What it feels like to be a clinician navigating "Medicine Inc."

If you are in the business of marketing to healthcare providers, I strongly recommend the book. Dr. Nuila effectively describes the causes of systemic breakdowns and offers practical proposals for solving them. But what I find most compelling is his depiction of what he calls “Medicine Inc.” and how it impacts a clinician’s psyche. Not only do clinicians witness the human toll of the system’s dysfunction, but they absorb it, too. For example, Dr. Nuila describes a patient suffering from gangrene in all four limbs due to a post-operative infection. Without the insurance to cover the appropriate treatment (amputation), she is left living each day with dead extremities while infection continues to spread. Imagine what it feels like to be an attending nurse or doctor helplessly watching a patient suffer while knowing exactly what must be done — but unable to take action because of financial considerations.

We’re selling a new age of medical discovery while unable to deliver basic care

In recent years, the business of healthcare marketing has been focused on ground-breaking scientific advances, especially in diagnostic technologies and pharmaceuticals. Marketing budgets are concentrated on these because of their profit opportunity, placing marketing professionals in a bubble that can lead us to believe our healthcare system exists solely in a new golden age — and we assume the HCPs we target believe the same. In reality, emerging medical miracles aren't able to cure the system’s inability to deliver basic quality care for the majority of the patients HCPs treat. In simple terms, breakthroughs don’t break through if patients can’t afford them.

It is easy to assume HCPs will get excited about new medical products that have the potential to cure or control a chronic disease or create efficiencies that make healthcare faster and cheaper. But their real-world view may be dampened by their struggle to deploy these breakthroughs for patients hitting a paywall.

We have to work harder at devising marketing strategies that honestly consider and respond to the HCP’s internal struggles. It is no longer so easy to tout a medical miracle — the narrative also has to connect to the day-to-day struggles HCPs face so that you earn their trust, a lesson that Dr. Nuila powerfully conveys in The People’s Hospital.

Dot Roar is a marketing communications firm helping healthcare companies better-connect with clinicians and institutional administrators. It begins with understanding the complex, controversial, and dynamic environment these individuals work in every day. If you’re interested in learning more, please contact us today.

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