Canadian Breakthrough

A few years ago, when the Provence of Quebec took over the financial responsibility for medical care, one of the changes the government instituted was to forbid patient families from calling pediatricians after office hours--and pediatricians from calling their patients during the same period. Calls were handled instead by a call center manned by nurse practitioners. The logic was that strangers who were not emotionally involved with both the patient and the family were less likely to pursue investigations of complaints. They had some experiential evidence for this. They had some support from physicians, who generally hate the unpaid for time and inconvenience of on-call schedules. The patients initially objected but eventually did not complain much. Change in quality was difficult to assess.
That this idea was somewhat successful is an example of bad concepts becoming first tolerable and then laudable. Imagine the notion that encourages indifference to the patient. Only the coldest organization could consider it.
The relationship between physician and patient is unique: The physician pledges to put aside all considerations in dealing with the patient other than the patient's illness and how the physician can help. The patient will never be a client, a customer, a sexual target. The patient will always, always, be primary. This placement of the patient in the center of medical care is the one aspect of medical care that makes it different; it can never become anything other than medical care. The relationship can never become commercial, can never be entrepreneurial or seductive. And it is this specialness that government must destroy in order to control price.
If the patient is of primary concern, an outside agent will never be able to manage medical care. If the patient is to be replace as the focus of care, there is only one way to do it: The physicians will have to change. Those who cannot change, will have to leave.