The Ugly 800-Pound Gorilla in Medicine

By guest blogger  Neil Shah 

(a fellow first-year at Keck)

Profit.  Greed.  Insider trading.  Economic crisis.  Words like these often come to mind when business is mentioned on the local news or in everyday conversation.  For anyone who's seen The Wolf of Wall Street, I can add a few more associations to the list.  Corruption.  Tax evasion.  Fancy yachts.  And of course, sex and cocaine.  Now contrast these terms to the poetic language spewed out by medical school applicants across the country to describe their prospective profession.  Noble.  Heroic.  Compassionate.  And the granddaddy of them all, “a chance to help others”.

STEVE BREEN
 © 2011 Creators Syndicate

To many in the medical world, business is an evil monster that is inherently at odds with everything that health care holds sacred.  These strong sentiments, combined with the reality that finance and economics can be dry and complicated, have likely persuaded some to ignore important business issues altogether.  As a former health care management major and medical group intern, I plead that no health care provider follows this same path of avoidance.  Here's why.

 It's no secret that health care faces tremendous challenges due to rising costs, inefficiency, and poor access.  Sure, a physician can theoretically escape these macro-level problems by joining a group like Kaiser Permanente and letting corporate bigwigs worry about fixing the system.  However, I would argue that this attitude does a tremendous injustice to society.  As the leading advocate for their patients, a physician has the responsibility to ensure that their patients’ best interests are protected in any business decision that is made.  If the bedside perspective is not promoted in policy discussions and reform efforts by physicians themselves, the supposed leaders in medicine, then how can corporate executives be expected to do the same?

In addition, physicians should understand the economics behind diagnosis and treatment choices because of the unfortunate reality that patients are forced to consider their own pocket books when seeking care.  Prescribing an expensive drug to a patient without considering its affordability is almost as futile as prescribing a drug without considering its side effects.  In an ideal world, physicians would be able to work inside a silo free from monetary considerations, but America cannot afford to practice medicine that way anymore.  Doctors need to be informed about money because their patients will inevitably bring it up.  And I, for one, would be embarrassed if I could not comfortably discuss a patient's financial situation, especially given its dramatic correlation with compliance and overall health outcomes. 

© The New Yorker

Physicians spend a decade of time and tuition to become experts on science, and medical expertise should indeed be the main priority.  But developing a good business skill set is not a mutually exclusive goal and is well worth the investment.  So read the finance section of The New York Times.  Take business and health policy electives in medical school.  Heck, even go see an exaggerated, over-the-top movie about Wall Street and come make fun of us business students for having no soul.  Whatever you do, just don't ignore the 800-pound gorilla in health care because your patients and politicians certainly aren't.