Diagnosis for Democracy
Insights into the State of Our Union
A Blog by Rob Tenery, MD


September 10, 2012: The Widgets in Our Waiting Rooms

By Rob Tenery, MD on September 10, 2012

In the early 1900s, Henry Ford not only revolutionized transportation but all of American industry by developing the assembly line technique for mass production. The process has been labeled modernization. Consumer goods, previously available only to a select few, were now available to the ‘masses’. Later McDonald’s and Wal-Mart can be credited with similar accomplishments--- make available more products, while at the same time, producing them more cheaply.

This concept had its origins during the mid-seventeen hundreds in the United Kingdom with the awakening called the Industrial Revolution. More specifically, it was a transition from a manual and draft-animal labor based economy to a machine-based economy. (1) In more encompassing terms, it was a transformation where social changes and economic development were driven by technological innovation. Spurred by income rises, the demands of the working groups (consumers) increased in proportion to the availability. Previously resigned to less, the working class now wanted and could afford more of what they produced.

Although assembly line efficiencies increased the number of goods available, the quality of each individual product did not always keep pace. More did not always equate to better. Just because Henry Ford could put more of his automobiles on the road, did not mean that his Model Ts were better, or even as good as the painstakingly assembled cars of his competition. Putting aside profit motivation, one could assume Henry Ford’s altruistic goals were to raise the standard of living for the masses.  Affordability and availability were Henry Ford’s aspirations. Noble as his premise was, it also introduced the concept of duality--- products for the masses and the option of other, often better, products for those who could afford more.

With mass production also came a depersonalization --- a distancing of the producer from the consumer, not only because of wider distribution, but emotionally as well.  Since the investment of ‘blood and sweat’ was concentrated on just one small area in a series of steps, the worker had less opportunity to develop a sense of ‘ownership’ in the final product.

That was automobiles. This evolutionary transformation, called modernization, could just as easily apply to other disciplines. Although the practice of medicine is a blend of science and the ministry, with the explosion of technological advances, the delivery of health care services has evolved into an industry. Some would say medicine’s industrial revolution began with Sir Joseph Lister’s introduction of the sterile surgical technique with the use of carbolic acid in 1867. Others might claim the discovery of sulfonamide in 1932 by Gerhard Domagk or in 1928 when bacteriologist Alexander Fleming discovered that a mold, which would later be turned into Penicillin, killed the bacteria Staphylococcus aureus in a Petri dish.

These discoveries, as well as others too numerous to list, were pivotal in moving medical therapy from symptomatic manipulation with potions and poultices into a science that actually struck at the cause of diseases. They literally bought medicine out of the dark ages. At the same time, they set the delivery of health care on a path of predictable evolutionary changes mirrored in the automobile industry with Henry Ford’s introduction of mass production.

Once accepted as ‘the will of God’, the outcomes of certain diseases could now be altered, giving affected individuals a better chance at recovery. In conjunction, there also developed an obligation to make those discoveries available to other individuals who had also been struck down with these diseases. Sharing medical knowledge has always been an act of beneficence. Reliving pain and suffering had now evolved into curing. Distribution of knowledge and therapies to a widening patient base introduced a demand to increase methods of communication and production of instrumentation and therapeutic agents not needed in the past. What was once just a relationship between a doctor and his patient had blossomed into an industry that was necessary to supply multiple patients and their doctors with the latest technological advances.

Automation, or more efficient methods, had to be introduced to increase the growing needs of an expanding patient base. As production of these services increased, competition arose to make these services and technologies more readily available and cost efficient. Commercialization has turned many in the pharmaceutical and delivery side of health care into multi-millionaires.

To the stockholders, members of hospital boards of Trustees and those who are entrusted with the continuing viability of their institutions, their patients are being counted as income generators. To the pharmaceutical and medical equipment companies, they are thought of as customers. To the insurers, they are considered policyholders. Finally, to the elected representatives, who are involving themselves, more and more, in health care delivery, they are voters and potential donors. In this modernization of health care delivery, depersonalization is turning patients into widgets--- widgets whose feelings, pains or fears don’t matter; good for one thing--- to be counted. The more widgets one has and the more cheaply they can be produced (treated)---- the better. Most important widgets have no say in what happens to them.

Facing the future, these health care widgets (patients) may have only one remaining advocate, other than themselves, against the profit-makers, the payers and the rule-makers --- the members of the professional health care community. If one stops to think about it, the reverse is true also. Just as much, doctors need their patients as their advocates. To often, this co-dependency is forgotten.

The industry of health care the delivery is different from the art and science of caring for patients. With the explosion of technology, coupled with an expanding and demanding patient population, modernization is inevitable. The problem is coping with the depersonalization that comes with these changes.

When we hear certain physicians extol about the number of patients they see in a day or the number of surgical procedures they can squeeze into their schedules, they’re no longer talking about their patients, instead they’re talking about their widgets.

References:

1. http://en.wikipedia.org/wik/Industrail_Revolution




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