In previous posts, I’ve mentioned relative value units (RVUs) that are used to rate a doctor’s performance in an HMO setting. Dr. John Mandrola, called RVUs “The Corrosive Force in Medicine.” Since doctors are employees hired by health corporations, they have to perform up to a certain monetary standard. RUV monthly performance reports compare them to doctors around the country and a poor report can mean loss of their job. Most doctors owe hundreds of thousands of dollars when they go into practice and they can’t afford to be fired.
Mandrola, a cardiologist, says that doing ablations, catheterizations, stents, or valve replacements earns a lot of RVUs. However, listening to patients, examining patients, counseling patients, hugging patients earns very few RVUs. Doing important research, teaching colleagues, and reading the medical evidence about alternatives to drugs earns zero RVUs.
As I’ve said before, there are no points for being a good doctor who has happy, healthy patients because she/he is recommending nutrients and giving them lifestyle counseling, nutrition counseling, or stress counseling. Unfortunately, RVUs have become the primary unit of success. In fact this type of medicine ensures an abundance of surgeries, screening, and diagnostic procedures because they make money. Mandrola says in order to stay employed you can’t make waves, you must have good templates on your electronic health record so documentation is complete, and you have to do tons of procedures, all which makes you valuable to the corporation.
With one million – yes one million doctors on the loose in the U.S. making at least one mistake a day with their patients, it’s no wonder iatrogenic medicine is a major problem that medicine is also ignoring.
Doctors must realize the bind that they are in but Dr. Mandrola also addresses the problem of the inability of doctors to voice their concerns in his Medscape Commentary “Freedom Of Speech Is Also Needed In Health And Medicine.” Mandrola says that “Most editorialists are clinician scientists who depend on two things: industry funding of research and friendly editorial review in the future.” Therefore they can never be frank, or critical, or even truthful about modern medicine. He suggested that “In the past, doctors might occasionally hear plain speaking at medical meetings, but with the advent of social media and smartphones, candor is suppressed there too.”
On the ground, the doctors who are employed by HMO’s can’t make any waves. “Employment contracts come with strong no-compete clauses and warnings about harming the brand.” If you speak out you can be fired which is what happened to “an esteemed surgeon who spoke out on double-booking in the OR.”
You can join Medscape and read the whole unsavory article yourself. I mention it to remind readers of how hamstrung the medical profession has become. They are in no position to speak out against the drugs and surgery approach to medicine; they will not support alternatives; they will not support therapeutic nutrients; they will allow their patients to suffer drug side effects because they are afraid to speak out. The sheer stupidity of modern medicine is staggering.
Carolyn Dean MD ND
The Doctor of the Future®
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