For more than half a century, doctors were among the most reliable professionals in America. Today, this trust has eroded.
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For more than half a century, doctors were among the most reliable professionals in America. Even before modern medicine, when treatments have usually failed, patients admire the knowledge, dedication and compassion of their doctors. Today, this confidence has eroded, with deep consequences for the future of US health care.
Gallup poll only shows 44% of Americans rate the quality of care Receive as “good” or “excellent”, the weakest appearance since Gallup began to ask the question in 2001. Meanwhile, Trust the honesty and ethics of doctors It has fallen 14 points since 2021, falling to the lowest point of this century.
At first glance, you may assume that this fall has emerged from recent developments: COVID-19, political polarization and growing skepticism of the vaccine. Instead, today’s decline in confidence is the predictable result of decisions that have been set about 20 years ago.
How the bow is bent
To understand why patients are now rating their doctors so badly, we need to identify the full arc of modern medicine: how confidence was built, how it culminated and why it refused.
The bow began with the arrival of antibiotics in the 1920s and 1930s. Before then, doctors have more often offered the hope of patients and compassion, not the treatments. But with the availability of Sufi drugs and, later, penicillin, a doctor’s visit was more likely to prolong a life than shortening it.
The second half of the 20th century became the golden age of medicine. In this next part of the arc, discoveries in surgery, transplantation, chemotherapy and vaccines were combined with broader access through insurance funded by the employer and the creation of Medicare and Medicaid. Life expectancy went up every year and the public’s confidence in doctors increased.
But every bow turns. Until the 1990s, the daily demands of clinical practice had been shifted. Acute problems such as pneumonia or broken bones – conditions that could often be treated in a single encounter – gave their place to chronic diseases such as diabetes, heart failure and hypertension. These conditions require lifelong management: Frequent monitoring, drug adjustments and repeated monitoring.
As chronic illness became more common and as patients and patients struggled to manage these ever -present conditions, the result was an epidemic of heart attacks, strokes, cancers and kidney failures. The cost increased while the clinical results were stood.
Insurers, caught between increasing expenses and payroll resistance, had only one lever to pull: distribution. They put the high -ranking plans, imposed the requirements of previous authorization and refused more claims. Doctors, meanwhile, are assured by high patient satisfaction ratings, resisted transformation. Most kept in small offices, with a reward for service, a payment model that rewards the volume of results. Many who requested stability and greater compensation sold their practices to hospitals or private share companies. Few found the relief they hoped.
Because patients feel different now
As the gap between the patient’s needs and the physician’s capacity expands, access to care is constantly eroded. Appointments that once took days for the program began to extend in weeks or even months, both to primary and special care. And when patients finally passed the door, visits felt hasty. With doctors on average just 17 minutes per meeting, there was a little time to listen fully, explain in detail or follow.
The consequences were predictable. Delayed appointments have allowed medical problems to worsen. The tests they rushed led to incorrect diagnoses. And for patients they left to wait, worry or return with complications, the logical conclusion was that their doctors did not care.
The doctor’s refusal
Even when patients observed the increasingly compromised quality, most medical professionals participated in the belief that small corrections could repair the system and restore the doctor-patient bond. Pressure was pressured for a few more dollars from Medicare, slightly less billing documents and fewer previous authorized insurers. But with fewer than half Americans who are now sure of the quality of care they receive – and premiums are expected to increase by almost 9% next year – doctors can see that significant health care reform is needed. The era of denial is over.
Patients’ confidence has now collapsed. A minority of Americans assesses their care as excellent and their data supports them. Life expectancy remains the same in the United States today, as it was in 2010 and healthcare consumes almost one fifth of the Nation’s GDP, with half Americans struggling to afford their medical accounts. Clinical doctors ask is what can we do? Other industries provide answers.
Lessons from business twists
Clay Christensen observed that companies and their leaders resist the transformation until it is too late and destroys disasters. Intel’s recent matches show how even companies can once go from the best to the world to a “ran too”. The lesson on the medical profession: which recognize the crisis early enough and embrace bold strategies are those that survive.
Their approach and their final success fall into two categories:
- They maximize business excellence to close the gap between demand and capacity. In the 1970s, for example, Southwest could not match the most important carriers for the brand’s reputation, so it had to be costly. Chooses to maximize cooperation. The pilots, stewardesses and ground crews served as a tight complete team, following consistent steps at each airport. The planes turned in 10 minutes, not 30. This performance allowed Southwest to plan six flights a day (one more than the competition) without buying more planes or adding staff.
- They embrace new technologies that can increase quality and lower costs. Get Netflix as an example. What started as a DVD-BY-mail service that rotates early in the flow. Even before the broadband connection was widespread, the Netflix bet in the future. The model reduced costs, improved accessibility and higher quality projection. The subscriptions remained affordable, the households remained faithful and the company reformed the entire industry.
Healthcare can learn from it. In this scenario, doctors will participate together to achieve economies of scale, to work together in all specialties to avoid overlapping the services and minimize resource waste through the coordination of clinical care. In addition, they will apply the principle of specialization for the creation of high volume centers that are capable of providing high quality high quality with much higher performance and significantly lower costs.
Medicine could imitate this approach. Doctors will embrace the genetic AI, take a financial risk under a model, find ways to better control chronic diseases and strengthen patients to take more care. This will reduce the demand for doctors, devote time to their most complex patients and reduce exhaustion. But this scenario will not happen if the payment methodology remains “pay for volume”, or if new technologies are relegated to administrative duties instead of being implemented to improve clinical efficiency and efficiency.
Of course, there is a third feature: Doctors are clinging to denial. In this scenario, they continue to run faster and faster in the hallway, cutting more angles each year and hoping that small corrections will make the difference.
If this route is followed, the annual cost will exceed inflation, the quality will continue to decline, and the gap between healthcare prices and patients who can afford will expand. To fill in the gap, entrepreneurs will seize the opportunity and develop AI genetic tools that replace (instead of completing) doctors. When it comes that day, doctors will regret that they do not act while they could still.
