Pursuit of financial incentives, she argues, keeps us from thinking clearly, and simultaneously chills our willingness to criticize ourselves or our colleagues. A quote in her book from an orthopedic surgeon was especially telling: “The minute you see dollar signs in your patient’s eyes, it changes how you think.” And not for the better. 

I wonder whether this sort of economically-motivated willful blindness is rooted more deeply in the psyche of the American doctor than anecdotes about a few rogue orthopedists might imply. Our history certainly suggests as much: the American Medical Association (AMA) has, since at least the 1920s, again and again joined with insurance companies (or whatever partner of convenience happened to be available) to make universal healthcare — allowing all Americans access to the services that we provide — politically impossible.

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The reasoning has typically been a desire to avoid “socialized” medicine (still a potent pejorative nearly 30 years after the fall of the Berlin Wall), a defense that remains as politically effective as it is logically suspect. Why would an association of physicians not want more people to have access to healthcare? 

Occam’s scalpel leads us to an easy answer. The AMA’s raison d’être is to protect the interests of doctors, and so-called socialized-medicine would almost by necessity require us, as a group, to accept a pay cut.

Don’t get me wrong — getting paid well isn’t inappropriate, and the AMA is just doing its job. But there’s real dissonance in the expectation that on one hand our professional association should protect our financial interests (even at the cost of denying healthcare to millions of people), but on the other hand that we should ignore opportunities to make a little extra scratch by diligently avoiding unnecessary interventions. 

There’s a fundamental inconsistency here, and one that I suspect many physicians long ago identified, but, for whatever reason, have chosen to ignore. We should know better. We are willfully blind.

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