RUTHFULLY YOURS

Nothing proves the title better than the recent reinstatement of a mask mandate in San Francisco hospitals. Every clinical doctor knows the data overwhelmingly proves they don’t work “to prevent the spread of the flu, COVID and other seasonal illnesses,” the ostensible, official reason for re-masking.

Note the adjective “clinical” doctor to contrast MDs in the trenches caring for sick people with bureaucrat MDs who, like Fauci, have never cared for patients in the real world but who dictate how the clinicians must practice medicine.

For most viruses, a cloth surgical mask is as effective as a screen door on a submarine. When (not if) patients get sick with the flu despite healthcare workers wearing masks, who will be responsible to care for them? When patients complain that masks did not prevent illness, who will they blame?

For decades, federal regulations and bureaucratic doctors have been chipping away at doctors’ independence, authority, and valuation. The heart surgeon with the best results can charge more than the surgeon with poor results, yet both are paid the same: an amount much less than their charges and what Medicare determines as “allowable reimbursements.” These are not reimbursements — they are government-pre-determined, low-ball payments.

As an interventional pediatric cardiologist, this author’s charges for a cardiac catheterization in a critically ill newborn baby ranged from $1,500 to as much as $9,000 if a device were implanted. Medicaid paid the maximum allowable reimbursement: $387.

In the past, general physicians would refer their patients to surgeons with the best results for the operation the patient needed. Now they must send the patient to whatever institution (not even who) the insurance company has a contract with.

A personal physician is no longer chosen by the patient. The enrollee, not patient, is assigned a provider on a health plan panel. People wait months to get in for a 15-minute appointment during which the doctor spends most of the time looking at a computer screen and filling out forms. No one takes a history or does a physical exam anymore.

Patients leave doctors’ offices frustrated because they do not get what they need: time to talk to the physician with a sympathetic ear, have the doctor explain what is going on, describe the rationale for the treatment plan including risks, benefits, and what to do if it fails. All that takes time, but efficiency benchmarks do not reward the doctor who spends time with the patient. On a clinical scorecard, talking with the patient is an inefficient waste of time.

Patients expect their doctors to order the best medications for that patient’s condition and needs. That does not happen because the physician must use Step Therapy or “fail first” approach, choosing from a short list created by a pharmacy benefits manager (PBM) a medicine that is cheapest, safest, and therefore least likely to be effective. After the drug fails to work and the doctor documents this, he or she may move to the next level of approved and somewhat stronger drugs, which still may not include the one best for this particular patient. When patients are frustrated with lack of improvement, they won’t blame the PBM.

CoViD demonstrated how little authority remains with the clinical doctor — none! When physicians tried to use ivermectin, the FDA prohibited the drug, and doctors were censured and even fired. When clinical researchers tried to publish data showing the dangers of mRNA injections, their reports were censored, labeled misinformation, and the authors were canceled and banned from social media.

Bureaucrat MDs such as Fauci and Walensky were in charge of all patients while responsible for none and accountable to no one.

A 2003 study asked physicians why they were dissatisfied with practicing medicine. The most common answer was, “responsibility without requisite authority.” In fact, that was why many were quitting clinical care and a primary reason for the doctor shortage. In the past 21 years, physicians’ responsibility has remained unchanged, i.e., total, and yet their authority has been reduced to simply following orders from those higher up on the food chain — executives and bureaucrats, some with MD degrees.

The reinstitution of a mask mandate shows that doctors are now robots. They must follow orders they know are unscientific. They are forced to give patients a false impression of safety from contagion. When patients get the flu or CoViD (masks don’t protect), patients blame the doctors (and nurses too) thinking the caregivers are giving them bad advice.

Whether it is wearing a mask, taking a medicine, having an operation, when medical care happens and by whom, the unaccountable are in charge and those held responsible are powerless.

Welcome to government-run U.S. healthcare.