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Healthcare reform debate has marginalized doctors

Doctors will have less of a say in solving the problems with healthcare because they won’t deal with the “subliminal psychologies” dominating the healthcare-reform debate. Here I take a rough stab of characterizing those I’ve noticed in our ongoing healthcare discussion:

With all the talk about special interest groups in healthcare reform, there is another force afoot that is much more influential: psychologic interest groups. Here I take a rough stab of characterizing those I’ve noticed in our ongoing healthcare debate:

The Libertarians (L)- “Let the Market Sort It Out”

Characteristics of this psychologic construct include:

  • Free market sunny optimism
  • Faith in human nature, against all odds
  • Competition will assure price controls
  • Complete denial of the human frailty and greed
  • Cynical about humanitarianism

Fairy Tale Believers (F)- “I’m not comfortable with anyone going without anything

  • Insist on fear-based appeasement: if you don’t give them what they want, the peasants will come knocking at your door.
  • Secret elitist belief that I’ll get what I want anyway
  • Infantile inflexibility to alternatives from their beliefs
  • I’ll-hold-my-breath-until-you-cry-uncle form of debate
  • Discomfort with their own aggression or shadow side
  • Politically active

Distrustful (D) – “No stick is big enough”

Characteristics of this psychologic construct include:

  • Aggrieved, victim mentality
  • Some history of real inequities or being disenfranchised which colors all perceptions
  • Safety first – no quality control will ever be enough
  • Doctors are greedy and will work best a pernicious, punitive environment
  • Group oversight is superior to individual oversight
  • There can never be enough bean-counters
  • Politically active – often protest marchers

Alfred E. Neumann (A) – “What Me Worry?”

This group never has healthcare issues until they do. Characteristics include:

  • Immature, emotionally unmodulated
  • Extreme anxiety/neediness in the hospital but complete denial when they hit the exit door.
  • Discussions of doctor availability are of no relevance until they are pressing the nurse call button
  • Politically inactive, rarely vote

So, which are you?

To date, many doctors have lived in our own fairy land when it comes to healthcare policy. We have preferred to insist that human beings will think in a fair-minded, scientific, data-based manner. Who would have known that we should have had a psychology or marketing degree? Perhaps this is why the debate has become so divisive.

Unless we address these powerful, subliminal psychologies head-on, our influence on the larger social policies influencing healthcare delivery in the future will remain limited.

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005. He writes regularly at Dr. Wes. DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.

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