Friday, June 15, 2007

A No to Institutional Oversight of Professionals

My recent posting on this subject elicited the below spirited response from good friend and fellow parishioner Kathryn Earle.

I am writing to respond briefly to your recent article, "What Happened to Professionalism?" and particularly to your conclusion: "I think it means that health care professionals have to be brought under the institutional oversight of institutions, such as hospitals or group practices, that are held accountable for the performance of the professionals they supervise. It means that we have to learn to put our confidence in institutions rather than in individuals." The major reason healthcare professionals are no longer as purely motivated by "doing the right thing" by each patient, as they once were, is that now, our basic system encourages inefficiency and distortion at best, corruption at worst. The insurance companies have become like many unions; the value they add is not commensurate to the price we pay for their services because the institutions themselves have become ends. Their own success is more important than the overall health of the system. Health professionals have as strong ethics and ideals as ever, but the system has absolutely beaten out of them their ability - and also, after prolonged abuse, their willingness - to deliver the very best care. Unless the public insists that the institutions change so that the major players in the system must interact in ways calculated to elicit quality of care and the satisfaction of patients and professionals, first, and value to stockholders and their satisfaction, second, I would argue that bringing health care professionals any further "under the oversight of institutions" would be disastrous. People naturally will do the right thing, but our systems are now set up to protect money-making rather than the people and the processes that serve them. Very few institutions will protect people incorruptibly past the point of their maturity, because most if not all institutions take on lives of their own, after a while, and lose sight of their original values. We, the people, must never entrust our safety and wellbeing to institutions for any length of time without periodically, vigilantly, monitoring and improving those institutions' service of the common, public good. If consumers do not insist on radical changes to the health care system, quality of care and nearly everyone's satisfaction with it will continue to erode.

And P.S., the same is true of our national government and the American people as a whole! But that's another subject.

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