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Lessons from the Medical Clinic

Applying Lessons from the Medical Clinic to the Social Clinic

Lessons that physicians learn in the Medical Clinic are applicable to a Social Clinician’s work in the Social Clinic. Among the most important lessons:

Take a complete History, look for patterns within it, and critically examine assumptions and conclusions: In the Medical Clinic, physicians learn how important it is to obtain a complete and accurate history from each patient, look for and recognize patterns within those histories (patterns that are similar to those seen in past patients), and critically examine assumptions and conclusions. That is the key to diagnosing with accuracy, understanding cause, advancing knowledge, and determining how to best help patients.

Much harm can occur when physicians fail to take a complete or accurate history, fail to recognize and react to patterns, and fail to critically exam assumptions and conclusions—not to mention what happens when physicians run away from the challenges of determining diagnosis, pathogenesis, and best treatment.

In the Social Clinic, it would be helpful if people like Clinton, Trump, and Obama (and the American people) would take a complete and accurate history of American geopolitical/economic interventions, look for the patterns within that history, and critically examine the assumptions and conclusions of American leaders and much of the American Public (particularly the acceptance of the American economic model and the presumption of American Exceptionalism and Indispensability).

Instructive Caricatures of What’s Wrong:

In the Medical Clinic, caricatures of disease (as opposed to more subtle versions of disease) often help physicians to learn more quickly and definitively.  Milder forms of disease are more likely to go undiagnosed and untreated, even denied. Obvious, florid forms of disease force recognition and action, and their exaggerated characteristics make it easier to appreciate what, exactly, is wrong. Caricatures of disease, therefore, accelerate Medical Progress. Good physicians learn from the florid caricatures and apply that knowledge to disease along the milder portion of the spectrum. Physicians who do not learn from the caricatures fail to understand the entire disease spectrum, and fail to diagnose and treat even the severest end of the spectrum.

In the Social Clinic, it is possible that the behaviors of the Bushes, the Clintons, Obama, and Trump (especially Trump, but certainly not limited to Trump), by serving as “instructive caricatures of what’s wrong” with the USA (its thinking, its geopolitical/economic interventions, and its underlying economic model), could actually accelerate Social Progress—if (and probably only if), at the same time, the American people critically examine American geopolitical/economic history and the economic model behind it; and develop a kind and sound alternative economic model as a potential replacement for the current model.

Patient Education is essential and therapeutic; Mystification is counter-therapeutic:

In the Medical Clinic, an important aspect of effective care is explaining patient histories and disease patterns to the patients, so that they can better understand diagnosis, cause, treatment, disease course, and prognosis. Clinical care is sub-optimal if the physician understands the patient’s history and disease pattern, but the patient is left mystified and confused. Good physicians are good and caring teachers and spend the time necessary to help their patients to comprehensively understand their illness. De-mystification is therapeutic; persistent mystification is counter-therapeutic. Proper education builds confidence, trust, an appropriate sense of control, and a healthy resolve to do what is necessary to get better. Mystification breeds distrust, despondency, helplessness, hopelessness, and inaction. Good physicians take responsibility and assume leadership for effectively educating their patients, and insist on taking the time to do so.

Likewise, in the Social Clinic, it would have been helpful if people like the Bushes, the Clintons, Obama, and Trump had educated themselves and the American people about the true history of American geopolitical/economic interventions, the true nature of the current American economic model, and what a kind alternative economic model could be. Unfortunately, they did not educate themselves or the American public, regarding these matters. De-mystification would be therapeutic; persistent mystification has been enormously counter-therapeutic. Proper public education, starting with education of the Teacher-in Chief and those who advise and influence him/her, would go a long way to reduce the confusion, distrust, anger, fear, unrest, despondency, and the geopolitical/economic misunderstanding and mis-action in American society.

Economic Models Matter:

In the Medical Clinic, physicians learn, first hand, how economic models can either improve patient care and outcomes or adversely affect patients.

As a physician, I have simultaneously experienced two completely different economic models that have been practiced in parallel—one based on economic altruism (the Academic Pediatrician Economic Model), the other based on capitalism (the private, for-profit health care model)—and I have personally seen how the former enormously benefits patients and the latter hugely harms them.

The Academic Pediatrician Economic Model is an altruistic, non-profit, public, budget-based model. It is designed, first and foremost, to meet people’s needs. It is based on the premise that Health care is a human right—that patients deserve to promptly receive the comprehensive care they need and that their care should be paid for by the Public. Budgets are based on cost-based pricing, not price-based costing. The physicians are given an appropriate work load that gives them ample time to meet the comprehensive needs of their patients.

The Academic Pediatrician Model is a collaborative, altruistic, efficient, group-oriented, freely sharing, internationally uplifting, non-hierarchical model, led by natural leaders and a high spirit of emulation and innovation. Its practitioners are held strictly accountable. It up-regulates and rewards Human Goodness and down regulates selfishness.  The participating physician (or nurse) is rewarded not just with appropriate reimbursement (as opposed to under or over reimbursement), but even more so by the gratification and meaningfulness of the work, the group spirit, and the comfort of knowing that their organization intends to take good care of them. It leads to equitable incomes, reciprocal kindness, and an abundance of Public appreciation. By matching physician workloads with patients’ needs, it leads to excellent health outcomes, at an appropriate price for Society.

The Academic Pediatrician Model is not just an idealistic theory—it has already been practiced for many decades, with obvious proven success, to the great benefit of societies, at a bargain price for societies—and, it is replicable, beyond the health care sector of the economy—translatable to the general Social Economy.

The capitalist health care model, in contrast, is a non-altruistic, for-profit, autocratic, non-democratic, price-based system designed primarily to make money. It is based on the premise that health care is a privilege, not a right. Patients must pay excessive premiums for their care—priced to generate profit for the health insurance businessmen. Many restrictions apply. Much care is denied. To maximize profits, this model seeks to avoid spending money on patients’ needs, rather than meeting those needs. The model promotes price-based costing, rather than cost-based pricing. Physicians are treated like assembly line workers, being paid by the piece, while not being given sufficient time to perform their piece work optimally. It is a hierarchical, non-collaborative, destructively competitive, duplicative, inefficient, risk-averse, regulation-averse, non-sharing, individualistic, internationally exploiting model that is usually led by power seeking individuals who are primarily committed to the financial bottom line and have below average capacity for empathy (or are chosen because they are willing to sacrifice empathy in favor of the bottom line).

The capitalist health care model up-regulates and rewards selfishness and down-regulates and punishes altruism and empathy. Physicians are rushed, and don’t have time for proper patient evaluation, much less proper patient education and follow-up or research. The patients I personally care for are continually and increasingly denied the evaluations and treatments they desperately need—and this has become the norm throughout the USA. Patient outcome has become poor, despite huge expenditures. Furthermore, this model leads to social consequences—income inequality, injustice, debt, distrust, anger, resentment, unrest, depression, chaos, loneliness, and Social Suffering. Instead of creating health, it creates more illness.

Use of the capitalist economic model in health care has been an obvious, obscene disaster—not a theoretical disaster, but a repeatedly documented obstruction to proper care, with grave consequences. Moreover, it is unsustainable from a purely economic standpoint. (It is bankrupting.)

To the Social Clinic: To many physicians and most patients, it is obvious that there should be no place in Health Care for practice of the capitalist economic model—not just morally, but practically and economically. To patients and many physicians it is obvious that the Academic Pediatrician Economic Model is far superior to the capitalist economic model—obviously so in Health Care. But it is also obvious to many of us that if the Academic Pediatrician Economic Model is very appropriate and successful in the Health Care Economy, it would also be appropriate, successful, and preferable in other sectors of the general Social Economy. Why not develop a democratic Public Economy that applies the Academic Pediatrician Model to all other important, needed sectors of the economy? Why not have a Public Bank, a Public Pharmaceutical Industry, a Public Train Industry, a Public Food Industry, a Public Energy Industry, a Public Automobile Industry, a Public Insurance Industry, a Public Construction Industry, a Public Cell Phone Industry, a Public Computer Industry, even a Public Toiletries Industry (to make the razor blades, toothbrushes, etc. that we need, for a fraction of the price being charged by Proctor and Gamble and Gillette)—with each such Public Industry being guided by the same principles, attitudes, and commitments that characterize the Academic Pediatrician Economic Model—none seeking to make a profit—all simply seeking to meet people’s needs—excellently, efficiently, altruistically, and inexpensively—with cost-based pricing, rather than price-based costing. Surely, the American Public is fully capable of doing at least as good a job as the private sector has done—without the over-pricing, excessive profiteering, and exploitation of workers that has been exhibited by the autocratic owners of private businesses for decades.

Just because the Bushes, the Clintons, Obama, and Trump have shown no interest in developing a democratic Public Economy (as an alternative to, or replacement of, an economy dominated by autocratic profiteering private sector companies) does not mean that the American people cannot seek to do so. After all, the private sector has failed miserably and has acted totally irresponsibly in the health care economy, and has also behaved extremely irresponsibly in most of the rest of the social economy (e.g. in the energy sector of the economy and in the banking/finance sector of the economy). With the replicable Academic Pediatrician Economic Model serving as an example, imagine a national Public Economy in the US and a collaborative network of independent democratic national Public Economies throughout the world, each based on creative versions of economic altruism, each nation generously helping each other to become the best each can be. That is how current global Social Suffering can be transformed into global Social Beauty.

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