Saturday, July 21, 2012

I Know This Is Crazy, but...

     I know this is crazy but sometimes I wonder if there is a plot to put every solo doctor out of business.
     Although I am not a conspiracy theorist, I've been adding up the benefits to big business and politicians if all doctors were under lock and key.  If we were "owned" by large hospital groups, national corporations, or bureaucratic university systems, our ''freedom" to practice as we liked wouldn't be so free.  We might be seduced into believing we are free--the way people whose brains are injected with daily Fox-News media-bytes believe their thoughts are free.  But thought and regurgitation of thought are two different things.
     Doctors believe they're better at independent thought than pop-media-junkies.  We've been highly trained, after all.  We can navigate our way through the jungle of signs and symptoms to the bubbling spring of a diagnosis.  We untangle the intricate knotted silver chains of lab values, murmurs, and reflexes to establish a line of reasoning back to a causative agent.  We listen and doubt, listen and surmise, listen and predicate all day long.
     But we doctors are the victims of slick advertising too.  Maybe it's because we're human and our appetites for flattery and blandishments are huge.  Maybe we want to be sold a bill of goods that promises an easy life.  Although we're not the right market for Sugar Pops or condominium time-shares, we're a market nonetheless--for a slightly more subtle "product," the product of being a wage-earner, not a business-owner.
     Here's what's on this week's cover of Medical Economics--the physician's magazine for "Smarter Business, Better Patient Care."  The lead article is "Owner or Employee?"  The subtitle is "Keys to making the decision."  The background color is faded-out hospital blue, but there's a glow of white around the central image like the hazy halo that enspheres icons in religious paintings.
     The image--which occupies more than half the cover below the banner--is a keychain with two silvery attachments:  one is an ordinary key and the other is a detailed replica of the caduceus. The caduceus lies on top of the key, perhaps prevailing over it.  The key signifies "owner," but it also conveys the responsibility and drudgery of a business.  The caduceus--which is on the left side in the picture (therefore first, valued more, since our eyes move from left to right in the English-speaking world)--is a symbol.  Symbols carry a great deal more weight than signifiers.  A symbol is numinous, meaning it has the fullness of the sacred--it evokes reverence, it's magnetic, it is an enchantment.
     I stood at my mailbox separating the day's mail and glanced at this cover, making a lightning-quick decision:  I want the caduceus.  Who wouldn't want to be a doctor, with its magical connotations, the commitment to humanity, a higher calling?  My automatic response bypassed intellect--exactly as good advertising intends--and enthralled me with the symbol of my profession.  I felt honored, looking at the caduceus.  "Who needs the donkey-work of a business?" nudged a little voice at the back of my mind.  The key stood for all my boring, quotidian, business-owner tasks.  You're better than that!  the image told me, and the effect was total.  It was 10 pm.  Tired and depleted, I had just driven home from work.  The magazine was right--I didn't want the hassles of a business!  I wanted someone else--an employer!-- to assume my problems and liberate me to my sacred calling:  doctor.
     Today's polished, psychological advertising works like this.
     Why should the government or big business care whether doctors work alone or under the masthead of enormous enterprises?
     Whenever I ask--Why?--about anything that has political or corporate attachments the answer is always about money.  Doctors are big business.  If the powers-that-be own doctors they can tell them what to prescribe, how to practice, where to refer patient for procedures, how to funnel money for all these things into the pockets of avaricious CEO's--along with their insurance, legislative and pharmaceutical buddies, all divvying up the booty--who regard doctors as commodities, not sages, and certainly not saints.  As doctor-employees we become exploited workers.  We're not in sweatshops--that wouldn't look good!  But we participate in our own exploitation by falling for marketing ploys that stroke our egos and promise an easier life.  We're in glistening, clean, white-coat sweatshops.
     There are no easy routes to success.  I know that this is a platitude, but I have labored in my own business for twelve years and have basked in the freedom to practice, mostly, how I please.  It's not easy.  But I can't imagine selling out in order to take a salaried position with a government or a corporate-run clinic.  That would be falling for corporate sophistry:  because my calling is sacred, goes the message, I should devote myself fully to it.
     And the subtext?  Naturally, I should siphon all the rewards of my intellect and training to the moneymongers who flatter and cajole me, big bosses who have become so good at pretending that doctors are in charge they would exhort me to stand proudly in my caduceus-embroidered lab coat even as I give them my purse, my proprietorship, and my self-respect.

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