Health care for Americans is in disarray. Over the past 30 years, businesses have increasingly dominated the field, relegating doctors to a marginal role. Our ranking in medical care compared to other countries continues to decline.   When I began my medical career, CT scans and MRIs were nonexi stent. Scientific advancements and technology facilitated development of these and other diagnostic tools. These changes have improved care, allowing physicians to diagnose and treat patients more effectively. The integration of computers has played a vital role by ensuring better continuity of care, at home or in the hospital, through enhanced communication between doctors and patients. At the same time, motivated by profit, businesses such as insurance companies and hospitals have removed doctors from much of the medical decision-making process. I have been in private practice for nearly four decades, which means I am a small business owner with the independence to make decisions. In the past, private-practice doctors cared for patients in offices and made hospital rounds during non-office hours. This sometimes meant tending to hospitalized patients early in the morning, in the evening, or on weekends, but it was manageable. I trained as an internist, initially in a hospital and later transitioning to private practice after residency. Typically, I would see patients first in an office, getting to know them and their family members while treating them in a non-emergency situation. When they became ill and required hospitalization, I would act as their admitting doctor, overseeing the management of their care. During my residency training and experience, I learned when it was safe to discharge patients home. I also recognized the importance of maintaining continuity of care in the transition from hospital to home to prevent re-admission. Most importantly, I got to know my patients personally by asking about their backgrounds, including where they grew up, family life, education, jobs, children, military service, and concerns. This eventually led to a transition into end-of-life decisions. This is the humanity I brought to practicing medicine. However, hospitals and insurance companies viewed it as economically inefficient for private practitioners to care for hospitalized patients. Balancing hospitalized and office patients was part of my training, and most internists and family practitioners are adept at it. Despite this, with financial interests backing them, the “hospitalist” was born. What has been lost is continuity of care. Even with technology, office doctors assessing recently discharged patients have a limited ability to understand the full scope of hospitalization. Most of the time, when asked, patients and family members are unaware of the admitting diagnosis, let alone what care is necessary to prevent readmission. Hospitalists are capable, board-certified practitioners; however, many are young and lack experience. The most troubling aspect of this is they are employed by the hospital or contracted through affiliated physician groups. This arrangement may lead to economic manipulation of their contracts, affecting medical decision-making. How many hospitalists bear the burden of medical school debt, a mortgage, and a family to support? Can we blame them for hesitating to voice their opinions? Data collection is pervasive in society and is utilized to assess efficiency. Many hospitalists encounter statistical constraints when evaluating utilization, which includes length of stay, lab tests, radiologic images, and requests for specialty consultations. These factors can incur costs and diminish profits, leading to pressure on contracted doctors who are not in private practice to minimize the care they provide. This, of course, could be at the expense of your health. Hospitalists often lack familiarity with patients’ backgrounds, knowing them only superficially. This stems from being taught that such information is “insignificant” and not essential for medical care, making patients feel like they are on a conveyor belt. In private practice, hospital administrators cannot dictate my medical decisions.  Some of my colleagues have accepted their roles, remaining only in their office practice despite their training. In contrast, others in private practice continue to see patients in the hospital and office. Technology has allowed them to care for hospitalized patients through computer contact, providing real-time care. Communication from hospital nurses enables rapid medical decisions, ensuring quality care. However, private practice physicians are rapidly being driven out of the hospital environment by administrators skilled at creating contracts that compel doctors to adhere to the bottom line. Ironically, the data collection now directed at doctors reveals the dire health care conditions Americans endure due to the poor decision-making of hospital administrators. The business takeover of medical decision-making, the loss of continuity of care, and the fewer doctors in private practice with an increasing number of contracted physicians susceptible to coercion harm our nation’s health and well-being. Addressing these factors could be an initial step toward enhancing health care for all Americans. Dr. Gene Dorio Saugus The post Dr. Gene Dorio | Loss of Medical Decision-Making appeared first on Santa Clarita Valley Signal. ...read more read less