I know that all of my readers and all of my patients are committed to natural medicine as a health care system for themselves. I also know that every single patient I have and have had, has an experience to share where they felt they did not receive the care, support and concern that they thought they should have from conventional medicine. Many patients are sick of trying to tell their doctor about how natural health therapies and medicinals work into their lifestyle and then hearing the doctor say it’s all unfounded, ineffective and even dangerous.

But what may surprise many of these doctors is that each of these accusations can actually be levelled against the very health care system in which they believe so strongly. We all need conventional medicine because there will always be things that happen to us that would never be right without conventional treatment or intervention. Conventional medicine is often miraculous and life-saving, but we have all had terrible experiences including misdiagnoses, long wait times for care and often debilitating prescription side effects. But as long as we have the miracles, we will still turn to conventional medicine. But how much longer can our health care system continue to provide those miracles when it cannot even provide adequate regular care?

What used to be small patient-centered health care has become billionaires with profit-making companies buying up blocks of our health care system in order to create a broader portfolio. I’m sure everyone knows about Steward Health Care (a for-profit company), which owns 8 hospitals in Massachusetts and has recently filed for bankruptcy listing more than 100,000 individual creditors. The CEO, Dr. Ralph de la Torre, has been quiet regarding the financial distress of his company, but in a recent interview he was quoted as saying he understands the criticism he has received over his personal wealth in recent months, considering Steward's financial distress, but argues that these facilities in Massachusetts would not have survived without his company saving them from extinction.

Add to that the unexpected announcement that the partnership between Mass. General and the Brigham, which has been the case for 30 years, is now being dismantled as they merge. How exactly they are planning to combine 19 departments at Mass General with 16 similar departments at Brigham and Women’s is anyone’s guess, but it is surely not happening with the intention of keeping all the staff, nor providing better patient care. And this is just a year after Dana-Farber Cancer Institute announced that it would leave its partnership with the Brigham to partner with Beth Israel Deaconess Medical Center which was a blow to patients at the Brigham where 40% of the surgeries performed are cancer-related.

These dramatic and often devastating changes are because our health care system has shifted over the decades towards corporatization as though health care should be run in the way that a business is run. It is a very strong belief in the streamlining and cost efficiency of automation, regardless of the loss of jobs and the reduction in personalized patient care. A recent study found that at 15 large academic medical centers (such as U Mass which has taken over Memorial, Clinton, Marlborough, Fitchburg and Leominster hospitals) just 15% of Administrative Board members were medical professionals. This means that only a small percentage of the decision-making in our health care facilities is being made by those with medical training and knowledge. And this is not just among medical centers. Health insurance companies also employ most of their staff as non-medical administrative personnel, because the heavily automated systems they have developed to manage a patient’s care do not require a medical professional. In fact, these systems have safeguards to notify insurance personnel if the diagnoses and treatments recommended by a physician are “appropriate”.

“When you automate an industry you modernize it; when you automate a life you primitivize it.” – Eric Hoffer

This means that a physician is not free to recommend the best care for their patients. They have to work within a “step” system where they have to do one procedure before they can recommend another, even if they feel the preliminary step is a waste of time and money for a particular patient. Insurance companies will often deny coverage for a particular medication because it is not a “preferred product” of their insurance company. Many patients are actually far more aware of allergies, sensitivities and side effects of particular recommended medications than their prescriber, yet the prescriber does not have the authority to recommend something “out of the box”. Patients and prescribers are being forced into appeals with insurance companies for coverage that was “promised” to a patient, even when a prior authorization was provided.

Where does this leave physicians, many of whom became a physician to treat people, not work in an administrative office? What were we led to believe we should expect when we watched Dr. Kildare, Dr. Ben Casey, General Hospital, Chad Everett on Medical Center, Marcus Welby and dishy Dr. Kiley, St. Elsewhere, New Amsterdam and Chicago Hope? The reality is that our physicians now are exhausted, unappreciated and restricted in what they can offer and provide. And our physician is the one we turn to for help. He is someone from whom we want to receive the very best care possible. One pediatric ER physician said, “This is about balancing patient care, quality of care, access to care and equity of care vs. the bottom line” and right now with the huge corporatized health groups in Massachusetts, there is no balance.

And let’s not forget about nurses, often the unsung heroes of day to day patient care? In a new survey in Massachusetts, the Nurses Association discovered that 80% of nurses said that the quality of patient care had decreased through automation and reliance on long lists of required steps. The Boston Globe just published an article stating that policies within these behemoth corporations (such as Mass General / Brigham and UMass) are focused solely on “metrics and money”. This is echoed by many health care workers who feel that policies are driven only by the maximum financial reimbursement even among non-profit health care facilities. The more services are being divided and specialized, the more time caregivers have to spend navigating bureaucratic gatekeeping and following up on appeals after denial of care.

How long have you had to remain on the phone trying to get an issue with your health insurance company resolved? One of my patients had been in a rehab facility and when she was ready to go home, the office there told her she had to go home by ambulance instead of her family simply picking her up, which is what she had planned. So she did as she was told and then received a bill from her insurance company for almost $3,000 because the ambulance ride was not “medically necessary. The hours she had to spend on the phone with the rehab facility, the insurance company, the ambulance service and her therapist (just to deal with the stress of it all). So not only should the burden be on the provider and the insurance company and not the patient, but the bigger question here is why a Massachusetts Health Policy report last year found that the average cost for a municipally-owned ambulance ride was one of the highest in the country! Is it the gasoline or the payment to the driver? Do we have some state of the art expensive equipment that is not present in the ambulances of other states?

You may remember a time in Massachusetts when most communities had their own community hospitals. In fact the state funded a study of community hospitals in 2016 prompted by the closures of many of these facilities across the Commonwealth. They concluded that:

“Community hospitals provide valuable contributions to our health care system. These include their role in providing convenient and local access to services, serving government payer patients, providing services efficiently and at relatively low prices, and providing high-quality care.”

And yet despite studies such as these community hospitals continued to close, pushed out by policies at large district hospitals and exclusive contracts with ambulance services, insurance companies and other essential care groups. Health care systems force physicians and facilities to “specialize” or join a group which makes the idea of a full-care community hospital impossible. Just since 2005 across the U.S. more than 200 rural hospitals have closed as a result of this type of business model.

We also have allowed these restrictive and impersonal systems to limit what a physician can do for a patient. Now the primary focus for a physician is diagnosis and handing out prescriptions. If a diagnosis is not immediately discernable, then the patient must be passed along the chain to a specialist or for additional testing. There is no time for considering the diet, the life stress, the emotional strain or even the cumulative effect of chronic unresolved symptoms. So how are physicians actually using all the years of education and experience they have? The simple answer is that they aren’t. They are encouraged to refer and to rely on the automated systems that have been put in place.

And what about the role of pharmaceutical companies in this drama? Again, profitability and cost reduction are the goals, so it is not surprising that the insurance company will require three rounds of steroids before agreeing to foot the bill for a more targeted treatment approach. Antibiotics are given for any group of symptoms resembling an infection, often without even testing to see if it is bacterial or viral. Or if a test is done it may take days before the results are back so an antibiotic is automatically given anyway “just in case”. And this is even though the Centers for Disease Control have stated categorically that “antibiotics have no effect on viruses”.

All of this is a monolithic, unmanageable assembly line system and it is a system that is failing us. The human condition is unique to each individual and assessment of a patient’s condition cannot be reduced to an algorithm and a CPT code. We need our health to be viewed as dependent on our unique body environment, our history of illness, the life considerations that affect us daily, all of the things that make us human. This means that creating an assembly-line process to treat human illness as though it is a quantitative and objective process, does not work.

It may save money, but it certainly does not save lives.

Read Part Two of "The Worrying Future of Our Health Care" This Month!

Karen Clickner, ND is the owner of Conscious Body Natural Medicine, Inc., in Westborough, MA. For more information visit www.consciousbodynatmed.com