What happened to our Healthcare System?

Something is wrong with our healthcare system. Our country spends more per capita than other developed nations, yet we have some of the worst healthcare outcomes. Rising medical costs are making healthcare prohibitive. Access to the system is becoming a growing concern. Medical care has become bureaucratic, bulky, and inefficient.

I am a retired physician, a urologist, who has observed the healthcare system from inside and then outside medical practice since my retirement 23 years ago. I have gained insight into medical care through my family’s experiences. There have been obvious and increasing numbers of inexplicable, delayed, and frustrating events.

In addition to observing medical care through my own experiences, I have interfaced with practicing physicians through my advocacy for physician burnout and suicide. I recently interviewed several practicing physicians to prepare for this position paper on the state of healthcare in the United States. Many of my comments are based on the results.

The most adverse factor affecting healthcare today is the deterioration of the doctor-patient relationship. This relationship is the critical central point of medical care in our country. The patient and physician, often in the exam room, should make clinical decisions together. Therapeutic alternatives, along with the robust discussion of risks and benefits, allow the most informed decisions to be made. This may be time-consuming, and some may find it old-fashioned, but it is of critical importance. I believe that the doctor-patient relationship in our country is now, if not dead, severely injured. 

The deterioration of the doctor-patient relationship began gradually and progressed insidiously. The time of onset is debatable, dating back 30 or 40 years. In my urologic practice before 2000, the patient and I made nearly all healthcare decisions. In 2025, others often make the same decisions regardless of physician and patient input. 

My first recollection of an obstruction to this relationship occurred in the early 2000s. A physician assistant offered to conduct the patient’s pre-surgical history and physical examination. I thought that was helpful without compromising patient care. In retrospect, this practice hindered my understanding of the patient’s medical history. In addition, after performing this examination, it was my practice to then obtain detailed informed consent. This consent was then relinquished to the phone or the pre-operative preparation area. The informed consent was not as thorough, and the interaction during this was not as complete. A second early example of interference with the doctor-patient relationship involved drug guidelines. Sometimes I compromised. Often, I was required to select the guideline drug despite my preferences. 

The deterioration of the all-important doctor-patient relationship began in the past and evolved gradually. I blame the entire physician community, including myself. We relinquished clinical decision-making, seeing these as facilitating our practice. Often, this made our lives easier. We were told that these changes would facilitate patient care. In retrospect, they cancelled the doctor-physician control.

Today, overwhelmingly, non-clinicians, physicians on committees, government agencies, and large businesses make day-to-day clinical decisions. Roadblocks to effective patient care are often the result. Many non-physician decisions are nonnegotiable despite the desires of the physician and patient.

Consider a few observations. Committees now make decisions regarding the use of physical therapy and other therapeutics, the ability to see specialists, and the prescription of various drugs. Controlled substances may only be prescribed as a one-month supply, without refills. These particular one-size-fits-all governmental regulations treat all normal patients like drug addicts.

Restoring the doctor-patient relationship will require a concerted effort. Whenever an obstruction to this relationship occurs, physicians need to take back their position as the clinical decision maker. 

Reversing those changes will be difficult. Physicians must reclaim control inch by inch. Those who are now making the decisions will be reluctant to give back their power. Those making choices believe that their decision-making is superior to that of the physician. Many in positions of control have contempt for the physician. Many feel that they deserve to be physicians, despite their lack of training. 

I wish I felt more encouraged about the future of American medicine. It is critical for our future that our medical profession improve. A very dedicated and consistent effort to restore the doctor-patient relationship is required. The only hope is to reestablish this critical clinical partnership with determination and reclaim our precious healthcare system. 

William Lynes, MD