I am actually old enough to remember when it was different. My General Practitioner (GP) when I had the unfortunate experience of moving to a state that, it turned out, had only recently emerged from the ideological stone age only to shortly return to it again by the 1990s, Indiana, was independent. He was his own man He was own employer and living the American dream. And he had his office in a house near the county run hospital in that litte Hooser town that I had moved to from Big Tex.
I had, of course, been to doctors before but only rarely. When I was young, for instance, I rode my bike into a brick stairway and almost tore off my nose, something which required the doctor to come to our house and stitch it up. Think of that, doctor house visits! How backward!
In 1967 everything changed in terms of my health life and my life in general. One day while running track I could not breath. Eventually, after some false starts—including the idiotic your mother did it to you or it is psychosomatic diagnoses—I was informed that I had asthma.
Between 1967, when my asthma issues first appeared and introduced me to the joys of the need fir constant medical attention and visits to medical specialists, I was taken, after seeing my GP, to see an allergy and asthma specialist at the Methodist Hospital in the Oak Cliff section of Dallas, the Dallas neighourhood in which I and my family lived. My asthma doctor initially put me on cortisone which had the usual side effects which forced me off of it and on nebulisers.
When I moved to Indiana my GP replaced the largely ineffective nebuliser treatments with Kenalog, which at first was great despite requiring periodic hospitalisations, and which eventually proved ineffective or of limited help in the long run as well. Because of the declining effectiveness of Kenalog my parents took me to see a Internal Medicinist at a health care clinic south of Fort Wayne. He put me on several pills, including Theopylline, Albuterol, and Prednisone, which I remained on, with limited effectiveness but a lot of nervousness, until the 1990s.
Around 1993 or so I was put on Advair and Singular by an asthma doctor in Albany, New York. This regimen served me well, so well that I was able to do all my doctoring with my GP. Sometime in the 2000s the physician group I went to became part of St. Peter’s Health Partners—St. Peter’s is a large and increasingly sprawling hospital and health care centre in Albany--and eventually Trinity Health, a Catholic non-profit health care corporation. They also decided to move up the medical status ladder to Internal Medicine physicians.
Both of these moves—corporatisation and specialisation--point up something that has increasingly happening in American health care and in American medicine since the so-called Reagan Revolution. This processes was aided and abetted by the religious revival of neo-liberalism and its key utopian notion and symbol that the market was and is god. Deus ex machina! As a consequence the practise of medicine in the US has changed and changed, in my opinion, for the worse in many instances.
Since around 2020 when I started having stomach and bowel issues the doctors—and I mean doctors plural--I increasingly saw and continue to see in the Capital region of New York, are not independents. Instead they, whether GP or specialist like the heart specialist, the pulmonologists, the allergist and gastro-intestinal specialist I now see--work for corporations like the non-profit Catholic Trinity Health, the apparently non-profit Community Care Physicians (CCP), and, Albany Medical College and Medical Centre, the physician and medical testing arms of the non-profit Albany Medical College and Albany Medical Centre Like the modern and postmodern Western world in general all of these apparently non-profit corporations are private bureaucracies, modern bureaucracies, which, as Max Weber noted, are the dominant organisation in that putatively best of all possible worlds, the West. By the way, the last independent doctor I went to retired and passed his cases on to Certified Allergy Consultants, which has five locations in the Capital region and which I can find no historical information about. Welcome to the postmodern Western world, a world without history.
What these corporations do in the United States is mimic each other. Albany Med, for instance, has an MRI. So does Saint Peter’s Health Care Physicians, which is part of Trinity Health, and so does CCP. Each of these corporations, of course, and for financial reasons, want you to use their MRI, use their testing labs, use their physicians, and use their own portals, so they can keep, or at least try, to keep the monies from insurance—the private for-profit bureaucracies that really run health care and medicine in the US-Medicare, and the information they gather through health care visits and their patient portals— information, of course, is central to the postmodern core nation economy--in house, in the corporation. By the way, another portal, a physicians only portal, has been developed in Albany to allow said physicians and techs from the various corporations to see what their patient has been treated for by other corporations but this is not mandatory and chance is a factor in whether the various corporations put that important information up on the shared portal. Bureaucracy breeding more bureaucracies because of inherent irrationalities and inefficiencies in the already existing bureaucracies.
Despite all the bureaucratisation that has come with corporatisation, however, efficiency and effectiveness, which bureaucracies and their new digital aids are supposed to be good at, aren’t always either efficient or effective. I, for example, recently got a new phone number and set up a new email account and managed to get all these changed in my medical portals—there are four== portal accounts or so I thought. When I was asked to review the health information in my ENT portal I found they still had the old and now outdated information in health information despite having the new information in my accounts page. Redundancies are costly and perhaps unnecessary. Waiting times to see specialists can be and sometimes are long. It took me several months to get into see a skin specialist and Gastro, for instance. And just last week Albany Med's Gastro liver specialists wrote me a prescription for a medicine my G-I "generalist" had already given me, something I took the time to note in my permanent portal record on Albany Med’s brand spanking “new” and “improved” portal—another bureaucratic tendency the celebration of the ever new and improved--and which had proven ineffective save at making me dizzy and loopy.
And many wonder why “consumers” are so cynical and skeptical these best of all possible worlds utopian days. Next customer, err, patient please. Ding.
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