The Professional Mess

Originally published on ManageWithoutThem, 2009-12-23.

There is a very interesting interview with Dr. Thomas Dorman on the Lew Rockwell podcast entitled ‘The Medical Mess’.

Dr. Dorman talks about how placing an intermediary between a professional (the doctor in this case) and their customer (patient in this case) destroys the relationship between the doctor and the patient.

I think anybody, not just Doctors, who considers themselves a professional will recognise the sentiments Dr. Dorman highlights as common to the experience of being over-managed and under-lead in many a large organisation.

In summary:

• The intermediary breaks the clear ‘point of transaction’ at which point the consumer owns the service provided – creating arguments and errors which then require regulations
• Regulations require the professional to ‘code’ medical conditions and categorise medical conditions based on the codes specified by the intermediary
• Because payments are made based on these ‘codes’ it forces the professional to spend considerable intellectual effort on the management of codes – at the expense of spending intellectual effort on the service
• Also, ‘if there isn’t a code for something there isn’t a service’. So ‘codes’ must be manipulated to order to produce ‘a fair outcome’. This creates mistrust amongst all parties.
• Professionals then spend time ‘documenting things to the satisfaction of the inspectors’ rather than working on services. This amounts to ‘costs escalating exponentially’
• This intermediation process is ‘known not to work’ in that it doesn’t create a more effective services. So ‘there must be an agenda’
• This agenda is ‘control, rather than providing quality services’

Sadly, Dr. Dorman passed away earlier this year before I even listened to this podcast.  The ideas, as always, live on.