The art of medicine is dead. Back in the last millennium when I was a young doctor, becoming a physician meant that one had a "calling," which is quite different from "going into business." In those days being referred to as "doctor" meant you commanded respect and were esteemed. Back then the purpose of medical insurers was to see to it that their clients’ claims were paid. And in those days the purpose of the hospital was to provide care for the ailing patient until he or she was well and able to return home healthy.

Times have changed! CEOs and other "bean counters" have hijacked American medicine and run it as if it were a manufacturing plant. Their "calling" is to make a profit, and the goal of the insurer is to deny claims. The hospital’s goal, once the procedure or treatment is completed, is to get the patient out of there as soon as possible. The latest tactic in the health care industry is to supplant the physician with all sorts of "physician extenders," similar, I guess, to "beef extenders." The physician’s care is becoming limited to doing a procedure or supervising the treatment. There is no need for the doctor to have a relationship with the patient—the "extender" will do that!

Even we psychiatrists, specialists in forming therapeutic relationships with patients, talk more these days about neurotransmitters than about the angst of mental illness.

Calling a physician’s office is now less of a personal experience than calling an airline to get a reservation. At least the person making my reservation talks to me politely and takes time to explain things. My doctor’s answering machine, in contrast, tells me to hang up and call 911 if I am having a life-threatening emergency; otherwise I am instructed, after pushing many numbered options, to leave a message that may be responded to within 24 hours.

Physicians have been deprofessionalized. They are now just "providers" in a massive health care industry that is increasingly impersonal, detached, and profit driven. Fortunately for me, my career is in its late stages, and I am still able to practice the old-fashioned way. I have a small, one-man "cottage industry." I try to provide personal attention for my patients, answer incoming calls when possible, return peoples’ messages promptly, and (of all things) even do my own psychotherapy. But I fear, as do my peers, that there will be no doctors left in the future to take care of us with the personal attention, patience, and understanding that once was common medical practice.

Don’t get me wrong, I appreciate much of the new high-tech age. I love the ease with which the Internet connects me to information, and I value the convenience of my cellular phone. But I’ll take the physicians of yesteryear any day over today’s "providers." Those doctors did have a calling and did know how to practice medicine as an art form. They knew how to comfort and how to ease suffering, and they understood the importance of a therapeutic relationship.

The tragedy of American medicine falling from its Golden Age to what it has now become, is clearly a product of capitalism at its worst. When medicine is governed by health care planners whose only concern is profit, then the number of people who die because of premature discharge from the hospital amounts to a simple calculation of potential malpractice losses versus salaries saved. But if the person who died unnecessarily happens to be your loved one, the result is actually incalculable!

Perhaps if every business person or insurer working in the health care industry today was required to work on an oncology unit, intensive care unit, or psychiatric facility for a period of time, they would appreciate the actual nature of the profession of medicine rather than seeing it as just a business. Medicine was never designed to be a business, and it never has been a good business, as measured by typical business parameters. Yet, one of the greatest accomplishments of 20th century America has been nearly doubling the human life span. This occurred, not in the context of worrying about every dollar spent, but by persevering in the development of medical science and improving the practice of medicine.

We are no longer struggling with recessionary pressures in our economy as we were eight years ago when the dismantling of American medicine began for the sake of controlling inflation. With the explosion of wealth over the past several years, maybe we can get back to quality in medicine and let physicians run the show again. Business people can return to running businesses, and we’ll all be better off! 

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Dr. Winig is in private practice in Walnut Creek, Calif., and is a staff psychiatrist at the Contra Costa County Forensic Mental Health Unit.