Private practice

Abstract

PRIVATE PRACTICE has long been an article of faith among many physicians. Those who choose to run for political office in organized medicine often use the preservation of private practice as a kind of slogan for their political platform. And there is a segment ofthe practicing profession that even now is trying to develop a political power base to "save" the private practice of medicine. The term private practice seems to have a high place in the group think of much ofthe medical profession. But few seem to ask themselves just what does the term mean, what is good or bad about it or what is its relevance to the way much of medicine is practiced and much of health care is delivered today. For some, private practice equates with fee for service in patient care, and all that is good and bad about this system of payment. Proponents point out that only in this system is the doctor clearly working for the patient, since it is only the patient who pays the fee. They also point out that private practice, as exemplified in the fee for service system, best preserves privacy and confidentiality between doctor and patient, and is the system closest to what medical care is all about-that is, a patient who seeks help and a doctor who is willing and able to give help. And on the philosophical plane, it is held that the private practice of medicine fosters individual responsibility and individual freedom, or "free choice" on the part of patients. This system worked well in simpler times when there was more independence and less interdependence in patient care than exists today, and when physicians carried most of medical technology in their heads or in their black bags, and depended heavily on trust and confidence to bring what solace and comfort they could to their patients. But the times have changed. There is now much more interdependence among physicians in the way they practice, and much more interdependence among physicians, their patients and the third parties that pay for much or all the care. In this new and much more interdependent world of health care, one may ask just how private can private practice any longer be? The word private can be defined as pertaining to an individual person, private as opposed to public (that is, government), or private, that is, not open to the public, as in private property. Clearly, in these terms there have been serious erosions into the traditional private practice of medicine. There has been an obvious trend toward depersonalization of the doctor-patient relationship, patient care is more open to peer and public scrutiny, and even the courts are publicly examining what happens in the "private" relationships between doctors and their patients. One can only wonder if private practice is becoming an empty slogan, or even an anachronism in this modern day. In these days of high-tech medicine and of high finance in health care, there is a real and present danger that the personal and therefore private happening that occurs between a doctor and a patient, which is the very essence of medical practice, will be crushed by the massive steamroller ofmodern medical technology and the ever more bungling efforts in both the public and private sectors to limit the cost of health care. As traditional medical practice (and for many physicians this