Once upon a time, it was a physician’s job to help a sick person get well. It still is, but it has become more difficult because of production pressure, drug advertising, procedure-oriented reimbursement, and the tendency to maintain or enhance market share by acquisition of megabuck technology. The relentless and expensive pursuits of the next marketing-worth piece of technology or gigabuck drug has left fundamental questions unanswered.

Gradually, physicians have succumbed to external pressures and internal motives to process patients in an industrial manner. The emphasis on efficiency (in generating revenue, not in effective diagnosis and treatment and maintaining quality of life) has led to the development of professional patient advocates — medically-educated people who are paid by patients for assistance in navigating the medical system. Advocates are trusted by the patient to help them avoid unnecessary drugs and procedures and to take the time necessary to adequately inform patients making difficult choices.

What does this mean? It means that patients (wealthy ones, at least) are finding value in having an advocate. When did physicians stop being an advocate for the patient? Thousands of years ago, when the first transaction for medical care occurred — the origin of the fee for service model of health care.  At that point, “care” became a commodity which relied solely on the physician’s integrity to isolate the conflict of interest generated by more diagnostic and treatment opportunities bringing in more income.

The rise of paid patient advocates is the predictable outcome indicating that physicians have often been unable to supply the integrity necessary to make fee-for-service work for optimal patient care. It’s no different than avoiding rip-offs by asking a mechanically-inclined neighbor or friend for advice before taking your car in for service.

Have physicians let their public trust, once unrivaled by any other profession, fall to that of a shady car repair place?  Can it be restored without leaving the fee-for-service model?  Until reimbursement depends on the patient’s quality of life and not that of the physician, nurse, hospital administrator, marketer and advertiser, that sort of trust is lost to the profession.