In recent years, consumerism and strong competition in the market for medical treatment have led increasing numbers of doctors to enroll in graduate business management programs, and hospitals have started to invite business management experts to give lectures. While interdisciplinary study is on the whole a good thing, the application of business principles to the medical profession introduces multiple conflicts of interest with traditional medical ethics that are likely to have far-reaching consequences. These need to be addressed as a matter of some urgency.
Commercial businesses focus on cost control and efforts to standardize, streamline and speed up the manufacturing process. Product specification must not vary and the more a company produces the better. In addition, products should be packaged well, innovative and offer added value. Ultimately, to ensure products are known to as many people as possible, advertisements need to be as big and far-reaching as possible.
Employees must not only be efficient, it is also better if they are able to work under stressful conditions. Commercial companies also focus on customer satisfaction and market share, and if they can gain a monopoly, then so much the better. Clearly, there is a great deal in this model of commerical operations that is simply inappropriate for the medical industry.
First, let us set aside the issue of life being invaluable and health being priceless. The same illness can manifest itself in different ways in different patients, requiring sometimes divergent treatments. There was once a cardiologist in Taiwan who was renowned for seeing more than 200 patients per morning shift. That record was recently broken by a renowned osteopath who is able to diagnose a patient in 86 seconds.
When asked what he thought about his popularity with patients, the doctor said he could “not help it” if patients like him so much. Even if the hospital management or his superiors are unaware of this situation, they are certainly skilled at making the most of this “golden goose.”
In terms of customer satisfaction, media reports indicated that most this record-breaking doctor’s patients are people who automatically respect doctors because of their professional position and perceived expertise. These individuals are also either unable or unwilling to develop an in-depth understanding of their own condition. When dealing with patients like these, doctors need only to have a good bedside manner and give them what they want: If its medication, write out a prescription; if they want an examination, issue a referral for an examination. With the help of computers, it is not that hard to provide a patient with a sense of “satisfaction” in 86 seconds.
Taiwan is full of political hacks who people vote for simply because they appear to be down to earth and friendly, so what if they have no political platform to speak of or have achieved next to nothing?
There is a hiking path close to where I live that surprised me with its beauty and tranquility the first time I walked it. The neighbor accompanying me told me that the path was something the local residents wanted to keep secret, and he urged me not to tell anyone about it because the place would be ruined if too many people knew about it. A scenic area does indeed quickly lose its appeal if a lot of people go there.
In the same way, a doctor’s physical and mental well-being can be undermined if he or she constantly serves the sick without rest or respite. It must also be said, that the rapid diagnosing of patients all but guarantees that the doctor in question has neither a quantitative nor qualitative understanding of a patient’s medical history. It is little wonder that doctors switch jobs so often after working from morning until late at night and seeing too many patients without obtaining adequate remuneration for physical and spiritual sacrifice they make.
Every business must of course make its operations as user-friendly as possible and hospitals are no exception. However, the heart of a hospital is not products but rather the medical treatment offered. The quality of this treatment is determined by whether the methods used are in line with the latest developments in evidence-based medicine. In addition, because the vast majority of a hospital’s “customers” know nothing about medical treatment, medicine and the respect it commands as a profession differs from that of other industries.
Furthermore, people are not lab rats and medical ethics prevent doctors from treating them in “innovative” ways. At the same time, such medical “products” do not have any “added value” and advertising them would be in breach of the Medical Care Act (醫療法).
What’s more, in the corporate world, companies that are not interested in gaining market share or market control simply do not exist. The medical world is different, in as much as the vast scope of medical science and the highly variable nature of clinical cases means that it is impossible to find a doctor who can understand the problems of every patient and treat them accordingly.
Doctors in Taiwan swear an oath that they will view fellow medical practitioners as brothers and sisters and that patient health should be of prime concern. Those in the medical profession are therefore encouraged not to engage in cutthroat competition but to instead establish networks that will enable them to help each other, work together in a complementary manner and refer patients to one another.
The reason the medical profession is respected in every society is that it is characterized by a humanitarian ethical code that plays little if any role in other industries. I believe the business-minded leaders of commercial enterprises make extremely important contributions to socioeconomic development, but society wil suffer if too many of these individuals make their way into the medical profession.
Kao Ko-pei is a doctor and an associate professor in National Yang-Ming University’s Department of Medicine.
TRANSLATED BY DREW CAMERON
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