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    How can doctors cure America’s ‘sickness’?


    Likewise with prescription drugs. It didn’t make it into the book, but this dermatologist prescribed an acne cream for a kid and the mother came back after going to the pharmacy and asked if he knew it would be $300. Doctors are caught off guard by prices all the time and it is frustrating for them. They have plenty else to do than calling around.

    I hope doctors can band together to demand [access to] those prices. It shouldn’t be an exercise in being a detective. They should know it. And that’s why I’m somewhat ambivalent about all these pricing sites both physicians and patients are going to. Yes, they provide useful information, but the bottom line is that knowing prices shouldn’t require detective work; this should be out there.


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     ME: Speaking of banding together, do you think doctors do enough of this to advocate for change in healthcare?


    ER: Doctors don’t do enough and it would be impactful if they did more. On the other hand, physicians are busy people who have another job, so realistically, it is hard. They didn’t go into medicine to become lobbyists. That’s not what they want to do, but I do think just as knowing about prices was not something they ever wanted to have in their wheelhouse, if we want to change the system, it would be great if they were more active.

    There are a couple of stories in the book [about physicians] who have taken it upon themselves to try and push back to seek leadership roles in their hospital, their communities or in local medical groups, and not through the specialty societies or the American Medical Association (AMA).

    I think the first ones out there [will] put themselves at considerable professional risk in that hospitals and insurers will see them as troublemakers. Someone joked to me after he started a campaign for more price transparency, he thought he’d drive to his hospital and find his parking spot taken away. And others mentioned more serious repercussions. 

    I remember in medical school, the big question for doctors was, “To whom is duty owed?” The answer, of course, is the patient. But it’s different if you are working for a big hospital system that says, “You have to do an MRI before you examine every knee, you have to order an occupational therapy consult on every patient who is discharged, etc.”


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    You ask, as a physician, particularly if you are a physician working for a big conglomerate health system that works very much like a business: Who is your allegiance toward? Is it my patient or my hospital/employer who can terminate me at will? The values of big hospital systems now are business values and not healthcare values, and that leaves doctors vulnerable if they disagree with the corporate culture.


     ME: This is also the case at smaller, independent practices, isn’t it?


    ER: The challenge I hear from many is that they are trying to work within a [healthcare] system they are uncomfortable with, and yet still feel good about what they are doing and get joy from it. It’s having that gratification of medicine not suffocated by the practical aspects of practicing today, which involves your payer negotiations, your hospital affiliations, your various professional certification requirements.


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