What patients need to do

When you interact with the healthcare system as a patient, your first concern is not reforming the system. Your concern should be getting what you need from a healthcare system that systematically subjects you to covert rationing. This means taking charge of your own healthcare and, by so doing, immunizing yourself against covert rationing.

This is not a trivial task. Having to resolve your own medical problems is frustrating. No matter how much time you spend searching the Internet, listening to the accumulated wisdom of your Great Aunt Hilda, or playing Twenty Questions with taciturn medical personnel, you can never be sure you have the right answer. The system today is not geared toward helping you; for it to work, you have to remain at least partially in the dark. That's what covert rationing is all about.

Still, there's a lot you can do to protect yourself within the healthcare system. You can empower yourself with knowledge. You can manage your relationship with your doctor so that, when it is time to covertly ration care, perhaps you will be the patient for whom he occasionally goes the extra mile. You can demonstrate a desire for-and show your willingness to pay for-the tools of empowerment. And when your ability and even your right to empower yourself are challenged, you can firmly stand your ground. The Surviving It section of this website provides more specific advice on self-empowerment.

What health professionals should do

Of the many negative ramifications to Quadrant III healthcare, only one directly affects all patients and all doctors all the time: the loss of the traditional doctor-patient relationship.

When we get sick, every aspect of the healthcare system we rely upon to restore our health is concerned mainly with not having to spend too much money on us. A concern about spending is to be expected-and it is necessary. We want regulators to be concerned about maximizing the benefits of healthcare for society. We want HMOs to be concerned about maximizing benefits for their subscribers. We want everybody to be concerned about spending our limited resources wisely.

But what we don't want is for our doctors-as they sit at our bedside and make decisions about our health-to be primarily concerned about the needs of society or about their continued ability to earn a living if they spend too much. We want them to be primarily concerned about our needs. Just like the citizen accused of a felony, we need that highly trained professional who takes up our cause and jealously protects our rights and welfare in the face of all opposition. For, as long as our doctors fail to assume their traditional roles as our personal advocates, we will be at the mercy of a healthcare system geared toward saving or making money. Thus, the deterioration of the doctor-patient relationship puts us in immediate peril.

The destruction of the doctor-patient relationship weighs on physicians more than on patients. While loss of this relationship may affect both doctors and patients all the time, few people are patients all the time, while doctors are always doctors. Doctors feel the loss every day of their lives. It is particularly frustrating to doctors that they have been coerced into becoming the engine of destruction of this relationship. Many of them understand, deep down and better than their patients, that without the classic doctor-patient relationship, their worth as professionals is fatally devalued; their profession is, in fact, ended.

Physician heal thyself

Is there anything doctors can do to heal themselves, other than leave practice and become florists, deep-sea fishermen, or authors? There is. They can find a way to create a demand for a restored doctor-patient relationship and then provide the means for achieving it.  The Surviving It section of this website gives some examples, and my book, Fixing American Healthcare, goes into some detail in describing how doctors can re-make themselves into facilitators of patient empowerment, instead of tools for covert rationing.