Medicine must be more of a ministry than a business
When I was about nine years old my family made a trip from California to Kentucky to visit my Aunt Becky and Uncle Doc. They live in a small town in central Kentucky. My Uncle is the town Doctor in addition to owning a large farm. While we were there, Doc was always in and out, mostly out. I remember one day in particular when Uncle Doc came in after a long day at the medical office. As I recall we had just sat down to eat dinner when the phone rang, one of his patients had gone into labor and he needed to leave. I heard later that he had come home in the early hours of the morning after having delivered this woman’s child. It was her sixth, and Uncle Doc had been there to deliver all of them. The woman was poor and had never paid for any of the deliveries. I am sure that it bothered my Aunt and Uncle some, but it was just part of the job—or should I say ministry? You see my Uncle had grown up in the area. As a young man he had felt a calling by God to serve his community by being the town doctor. For him it was a calling, a ministry. Sure it was a business too, and he made good money at it, enough to make him one of the richest men in town. But for him practicing medicine was primarily a ministry and the business aspect was a distant second.
I am sure that there are still a lot of “Uncle Docs” out there, but it seems to me that over the years, medicine has made a large shift away from ministry and toward business. There are a number of reasons for this. I must make a disclaimer at this point. I am not an expert, I have not researched this industry, and I don’t work in the medical field or even any related field. All of the following are my own observations and opinions. I welcome comment by anyone with a differing opinion or first-hand experience in the field.
The following list in not in any order of importance:
• An increase of doctors pooling resources and working together through medical center and hospitals. This has increased the likely hood of a patient seeing someone other than his family doctor. The ministry approach is closely related to the building of rapport and trust that builds through repeated contact over time.
• The growth in specialization. This has two impacts:
o The first is that often medical students are encouraged to go into a specialty because they can earn more money. This attitude places money as the primary goal and ministry as a secondary goal.
o Specialists tend to be brought in to treat a particular ailment. The focus is on the ailment not the person. The relationship is often viewed as temporary and therefore not important. The approach is task oriented rather than person oriented.
o This is not always true because even doctors with specialties can have a ministry approach. Some Specialists treat chronic conditions and end up forming a closer relationship with their patients than the primary physician.
I am primarily talking about hospitals but this can apply to any type of medical corporation. By definition a corporation must work for the benefit of the stockholders. Maximizing the return for stockholders establishes business as the primary focus and ministry must take a back seat.
I my opinion insurance is the problem, not the solution. Insurance more than anything made medicine a business. The growth of insurance created the need for insurance billing. Doctor’s offices, hospitals and others are spending up to 30% of their time and staff on medical billing rather than medical service.
The insurance companies have stepped between the medical provider and patient. Insurance companies are exclusively about making money; they have neither personal attachment to nor interest in the patient or the doctor as people.
Insurance companies have separated the medical service from the billing. Now the doctors are providing the service and a separate entity is handling the billing and collections. The patient has less opportunity to question costs or the cost vs. benefit of a particular procedure. By the same token, doctors and medical providers feel justified in charging more and more, because they are not extracting the money from a particular patient instead it is coming from a large, wealthy, insurance company.
• High-Tech Medicine
Modern medicine has become increasingly dependent on very expensive equipment and drugs. The large companies that provide equipment, medicines and supplies to medical service providers are detached from the patient. It is almost impossible for them to see their work as a ministry. Ministry happens one on one between people; it doesn’t happen through equipment, medicines or other supplies. Those items are commodities bought, sold and traded by businesses.
In addition, an increasing amount of “medical care” is done outside of the doctor’s office. Often you are sent to a lab for tests or a scan. Once again these are not part of the ministry of medicine they are detached technical functions to identify a disease. Now I can look up my test results on-line so the doctor will not need to interact with me directly. All of this is done in the interest of saving money (supposedly for the patient).
Lawyers have thrown themselves into the mix; suing doctors, hospitals, pharmaceutical companies and others. Of course there are times that these suits have been justified, but the end result has not been better medical treatment. For the most part it has led to a business decision to purchase medical malpractice insurance. Now if a doctor happens to injure a patient there is no interaction between the doctor and patient. Nothing is resolved on a personal level. Instead it is purely a battle between disinterested parties over money. The doctor patient communication is replaced by, “Have your lawyer talk to my lawyer.” Not only does ministry not happen, we have developed a system that prevents it from happening. A doctor cannot admit to wrong doing because it may give ammunition to the opposing lawyer. No correction happens, no restoration, nothing happens that is truly emotionally and spiritually healing.
Both my brothers and my wife have worked in Church ministry. Churches exist to minister to people, but there are business aspects to churches also. Facilities have to be managed, resources allocated, payroll met. There are a thousand ways in which a church functions as a business. What I have observed is that the more business there is in managing a church, the less ministry happens. Business and ministry seem to fight one another.
I think it is easy to see that our medical system has come a long way, but the direction we have been moving is away from medical ministry and toward medical business. Everything is judged based on money. Often the discussion is framed in terms of saving money for finding some way to more efficiently treat the patient. These are all business viewpoints. Gradually the doctor patient relationship is being eroded away. Doctors are treating diseases not people. Even medical care providers who have a heart to perform their services as a ministry are finding that the system gets in the way. There must be a way to simplify the medical industry and allow doctors to be ministers. We must reverse the trend and more from medical business and back to medical ministry.
Medicine must be more of a ministry than a business