HJNO Mar/Apr 2025

Healthcare Without the Patient: Only in America the last 70 years, we have witnessed the credibility of the American physician as the ultimate patient advocate seri- ously diminished, succumbing to pri- orities of government-sponsored health insurance programs, corporate and pri- vate healthcare insurance underwrit- ers, and managed care organizations. Traditionally, what is in the best inter- est of an ill patient and an anxious fam- ily has long been the role of nurses and physicians providing care, advice, and assisted decision-making during times of illness. What is new in post-COVID healthcare delivery is a fundamental re- alignment of hospital-physician interac- tion and relationships more akin to an employer-employee model with an esti- mated 60-70% of practicing physicians today receiving some sort of corporate compensation from hospitals. This trend, present prior to the COVID pandemic cri- sis, was only accelerated by a diminished physician voice to resist the intrusion of corporate-led priorities and decision- making incentives to the needs of patients. Corporate accountability to maintain pa- tient-centered delivery of care now seems a lost priority, only to be replaced with an overemphasis on profitability, market share expansion, c-suite compensation, and reductions in recruitment and com- pensation of registered nursing expertise. As employees, physicians are now re- cruited for their expertise, competence, and clinical performance, yet evaluated for their compliance — how well physi- cians follow the demands and directives of administrative employers, foregoing their traditional responsibilities as a patient ad- vocate. Hence, we are left with corporate- centered healthcare — the patient now a sideshow distraction, physicians now si- lenced employees of corporate healthcare delivery, to say nothing of an exodus of reg- Clinical Professor of Surgery LSU Health Science Center New Orleans, Retired J. B nton Dupont, MD, FACS istered nurse manpower from the bedside. In short, silencing of the independent physician voice as the ultimate patient advocate is truly the healthcare travesty of our time! In our endeavor to deliver 21st-century, patient-centered healthcare, there is a shared culpability of organized medicine and surgery, business and gov- ernment imposing the delivery model we are currently saddled with as a society. Ayn Rand’s 1957 Atlas Shrugged fore- warned us: “..... would not let them dictate the pur- pose for which my years of study have been spent, or conditions of my work, or choice of my patients, or my reward. In all the discussions that preceded the en- slavement of medicine, men discussed everything except the desires of the doc- tors. Let them discover in their operating rooms & hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe if he is the sort of man who resents it – and still less safe if he is the sort who doesn’t.” It would be refreshing, indeed, to see doctors once again starting to act like doc- tors and remain loyal to the oathwe took! n HEALTHCARE JOURNAL OF NEW ORLEANS I  MAR / APR 2025 65