Patients, especially when they are sick and least able to fend for themselves, are in dire need of an advocate, a professional who will take their part and protect their individual interests against the often competing interests of a hostile and complex healthcare system, whose only concern is reducing costs. Patients abandoned in such a system without their rightful advocate are in a very dangerous position indeed. This is why the classic doctor-patient relationship is so critically important. And this is why Emanuel’s position is wrong. If we are to control healthcare costs, we need to find some way of doing it other than to expect (or, more likely, coerce) physicians to place the needs of society ahead of the needs of their individual patients.
On the whole, Dr. Rich’s post offers a nuanced and respectful view of Emanuel’s writings. I’ve have a post in preparation in an attempt at a similarly nuanced view in response to a challenge from Orac, but Dr. Rich is a hard act to follow.