The American Medical System and Physicians 1: Professor Benoit Desjardins, MD, PhD, FAHA, FACR, FNASCI on the U.S. Medical System, and American Patients and Physicians

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): In-Sight: Independent Interview-Based Journal

Publication Date (yyyy/mm/dd): 2022/05/08

Abstract

Professor Benoit Desjardins, MD, PhD, FAHA, FACR, FNASCI is an Ivy League academic physician and scientist at the University of Pennsylvania. He is a member of the Mega Society, the OlympIQ Society and past member of the Prometheus Society. He is the designer of the cryptic Mega Society logo. He is member of several scientific societies and a Fellow of the American College of Radiology and of the American Heart Association. He is the co-Founder of the Arrhythmia Imaging Research (AIR) lab at Penn. His research is funded by the National Institute of Health. He is an international leader in three different fields: cardiovascular imaging, artificial intelligence and cybersecurity. He discusses: science; medicine; limits of science as applied to medicine; science fiction or science fact; human lifespan; the values of the medical field within the United States; venture capital firms decided to make medicine a business; venture capital firms; businesses made to appeal to patients with higher incomes; CEOs; American medicine; ignorance masquerading as knowledge comes to blows with evidence-based expertise; the lower strata of the educational and authority hierarchy in medical facilities; values and preferences of cultures; American patients different than others; American patients similar to others; pressure from administration towards physicians; rudest versions of this hotel mindset of American patients; American virtues; violent hysterics against Dr. Fauci; great examples of American ignorance; and mutually reinforcing trends.

Keywords: American, Benoit Desjardins, Dr. Fauci, incomes, Medicine, physicians, science, United States, venture capital firms.

The American Medical System and Physicians 1: Professor Benoit Desjardins, MD, PhD, FAHA, FACR, FNASCI on the U.S. Medical System, and American Patients and Physicians

*Please see the references, footnotes, and citations, after the interview, respectively.*

*This interview represents Dr. Desjardins’ opinion, combined to the current content of the published medical literature, and not necessarily the opinion of his employers.*

On science and medicine

Scott Douglas Jacobsen: Let’s start by defining terms, what is science?

Dr. Benoit Desjardins[1],[2]*: From Webster, science is the knowledge about general truths or general laws obtained and tested by the scientific method. The scientific method provides a set of principles for the pursuit of knowledge. It involves formulating a problem, collecting data by observation and experimentation, and formulating and testing hypotheses.

Jacobsen: What is medicine? 

Desjardins: From Webster, medicine is both a science and an art, dealing with health maintenance and the prevention, alleviation, or cure of disease. It used to be primarily an art, but it has become firmly based on science as science evolved.

Jacobsen: What is a physician? How does a physician differ from other terms of professionals within medicine?

Desjardins: A physician is someone educated, experienced, and licensed to practice the science of medicine. The difference between physicians and other healthcare professionals is becoming less clear with time, as other professionals take on more and more of the responsibilities of physicians.

Jacobsen: What are the ultimate limits of science as applied to medicine?

Desjardins: Nobody knows. Science progresses constantly, and new scientific discoveries that positively impact medicine are produced every year. There are often tradeoffs limiting the applicability of some scientific advances to medicine. Let’s take an example from my field. There have been advances in cross-sectional imaging to image humans at extremely high spatial resolution. Flat-plate CT scanners can do that but require more radiation, which is a limiting factor for human imaging. As a result, they are mainly used to image small animals.

Jacobsen: Some make extravagant, though grounded in the natural rather than the supernatural, claims about longevity post-human or trans-human states of human life, e.g., Ray Kurzweil. Where, indefinite lifespans for humans are realized and ideal health statuses are attained. What’s the current front on this, more science fiction or science fact?

Desjardins: I have no expertise in this area. I see it as science fiction.

Jacobsen: What fields show the greatest promise in helping extend average human lifespan and ‘healthspan’ in real terms?

Desjardins: I have no expertise in this area.

On practicing medicine in the U.S.

Jacobsen: What are the values of the medical field within the United States? How does this differ from other fields?

Desjardins: There are values related to the patient, including compassion, respect, and justice. Other values are related to the physician, including a commitment to excellence, integrity, and ethics. Physicians take a Hippocratic Oath and swear to uphold specific ethical standards. It differs from other fields. Healthcare is, however, a business in the U.S., which creates conflicts with some of its values. For example, many medical practices start with noble goals, trying to help their community with devoted, caring physicians who will do whatever is best to help their patients. These practices sometimes get bought by venture capital firms. After the purchase, physicians become indentured servants, forced to perform massive amounts of work (e.g., seeing one patient every five minutes). They are forced to do whatever is best to maximize shareholders’ and investors’ profits at the expense of quality of care and consequences to physicians’ health.

Jacobsen: At some point, venture capital firms decided to make medicine a business. Is there a documented timeline of this?

Desjardins: Venture capital firms started buying physicians and medical practices in the late 1980s, a growing phenomenon.

Jacobsen: When do venture capital firms decide, in the life cycle of nobly aimed medical facility, to buy them out now? It must be a systematic process now, as it’s been done so much.

Desjardins: I am not familiar with the field of business, but they seem to buy them when they are profitable or have the potential to become profitable from the exploitation of physicians.

Jacobsen: Since medicine became more of a business than less of one, what are some choices the businesses made to appeal to patients with higher incomes, where these have nothing to do with medicine, saving lives, or better health, simply appealing to the culture of the wealthy or, at least, the rich?

Desjardins: Some hospitals offer entire floors reserved for wealthy patients, with hotel-like amenities in their rooms and increased access to services and physicians, a limousine drive from the airport, and lodging for patients’ families.

Jacobsen: How do CEOs and others interact with physicians?

Desjardins: CEOs have minimal direct interactions with physicians. They often provide mass emails to their entire medical center staff updating everyone on current issues, such as the pandemic or new initiatives, the hospital system’s latest national rankings, or financial health.

Jacobsen: Why is American medicine seemingly so terrible at outcomes while, at the same time, so expensive too – including destroying the livelihoods of the individuals giving the care?

Desjardins: American medicine is known as the “great outlier”: it is the worst healthcare system among high-income countries (Commonwealth Funds) but at the same time is the most expensive healthcare system in the world. It has a high infant mortality rate, low life expectancy at age 60, and high preventable mortality. Its infant mortality rate is comparable to some third-world countries, like Sri Lanka (Worldbank). This poor performance at extremely high costs is due to multiple factors. It includes a minimal focus on preventive medicine, emphasis on fixing catastrophic health outcomes after years of neglect, the practice of defensive medicine, and the business approach to healthcare. The traumatic nature of life in America, and the high poverty rate, have significant harmful effects on the population’s health.

Jacobsen: Whether they have terrible health patterns (so their fault), have a bad physician (so not their fault), both (so both their faults), or simply an accident brought about by something unexpected (so neither patient nor physician fault), the reactions from these events can be misinterpretation or malevolence. Each with consequence.

Although, if medicine marks a business, perhaps, we, the non-expert public, can see the issue as a natural derivative of the customer service axiom, “The customer is always right.” How are these issues exacerbating expectations from American patients coming to American physicians with sophisticated ignorance, when ignorance masquerading as knowledge comes to blows with evidence-based expertise?

Desjardins: Physicians are required by their Hippocratic Oath to serve their patients as best as possible. They use an evidence-based approach to healthcare, which is good medicine that can sometimes lead to bad outcomes. The latter often leads to patients physically harming or suing their physician, as patients are too ignorant to realize that good medicine sometimes leads to bad outcomes. Physicians can respond to this situation in two ways. First, they can continue using an evidence-based approach for healthcare until they either get harmed by their patient or more likely lose their practice license due to too many frivolous lawsuits against them. Or they can adapt to an ignorant, scientifically illiterate society by doing “defensive” medicine. The latter leads to overutilization of medical resources, patient harm, and increased U.S. healthcare expenses.

Jacobsen: What about the lower strata of the educational and authority hierarchy in medical facilities? I mean nurses and the like. How is their education? Are they given the same quality of education? How does their education impact the quality of care for patients?

Desjardins: Every member of the healthcare field receives the best possible quality of education addressing the tasks they are expected to perform, ensuring the highest level of quality in healthcare at different levels. Problems arise when healthcare workers lower in the hierarchy are given the authority to perform duties and actions for which they have not been trained to decrease healthcare costs. It has led to patients’ deaths.

On American patients

Jacobsen: I’ve done extensive interviews with Distinguished Professor Gordon Guyatt at McMaster University on Evidence-Based Medicine and other relevant subject matter. He talks about values and preferences. How are these values and preferences of cultures impacting the expectations from physicians by patients in the United States?

Desjardins: I am originally from Canada. Canadians have a more socialist mindset, think about the greater good, and are more reasonable. Americans have a more individualistic mindset. They will not tolerate waiting lists like in Canada. If they cannot see their physicians rapidly or get the device or the operations they want, they get angry and can become litigious. They will expect physicians to spend millions on extending grandma’s life by a few weeks. They have gone to court to prevent unplugging of brain-dead patients (remember Terri Schiavo), with brain dead U.S. lawmakers forcing doctors to keep these patients on life support.

Jacobsen: How are American patients different than others?

Desjardins: They have no personal accountability. They do not take care of themselves. They can chain-smoke for 50 years and then blame their physician if they develop cancer. They expect their physicians to be at their service 24/7/365, an unrealistic expectation, to work all the time without getting tired, and never make a mistake. They fail to realize that physicians are human beings. They still think of physicians as wealthy, privileged people driving expensive cars and living in mansions. U.S. physicians are instead in massive debts from medical schools, massively overworked, cannot take breaks, and are often suicidal from their working conditions.

Jacobsen: How are American patients similar to others?

Desjardins: They get sick.

Jacobsen: You have been in practicing medicine for over 20 years. How do these expectations from patients impact the pressure from administration towards physicians?

Desjardins: There is increasing use of patient satisfaction metrics by the administration to judge physician performance, which I believe is wrong. Most factors affecting patient satisfaction, like waiting time or access to physicians, are entirely beyond the control of physicians. Hospitals in the U.S. are like hotels. U.S. patients have unrealistic expectations because of this hotel mentality.

Jacobsen: What are the rudest versions of this hotel mindset of American patients?

Desjardins: We see more disrespectful behavior from patients and their families against doctors. Some patients will refuse to be examined by a black, Muslim, female, or foreign physician or by a medical trainee, intern, or resident. They will get angry at physicians if they must wait a long time before visits, if the price of their medication is too high, or if busy physicians do not spend enough time with them. And, of course, angry patients often write bad online reviews against competent, dedicated physicians, negatively affecting the physicians’ careers and livelihood.

Jacobsen: Americans are scientifically ignorant, not necessarily individual faults. They are greedy, coming out of a culture based on the superficial things of life, though, at the end of the adult day, is an individual value, so can be considered their fault. Same with cruelty akin to greed. What about American virtues? How are these ameliorating this issue of overwork or poorly cared-for physicians?

Desjardins: Americans can display generosity, compassion, honesty, and solidarity. They often raise thousands of dollars in crowd-funding of patients for an operation, a transplant, or medication. Unfortunately, there is zero empathy in American culture towards physicians. When Americans are told of the poor working conditions of physicians, they simply respond that physicians chose that profession, and they should accept the consequences of working in that profession, even if this leads to physician deaths. When a football player commits suicide, this is extensively covered in the news media, and small local memorials are erected around which people can deposit flowers and pay their respect. When a U.S. physician commits suicide due to poor working conditions, their body gets covered by a tarp, and the death is not reported in the news media. When patients come to their annual physician visit, they are told the physician moved away. After dedicating their lives to taking care of human suffering, their existence is simply eradicated and forgotten. But Americans will remember the football player forever.

Jacobsen: Are violent hysterics against Dr. Fauci ongoing?

Desjardins: I don’t think they will ever stop. In December 2021, Fox News host Jesse Watters urged listeners at a conservative meeting to take a “kill shot” at Dr. Anthony Fauci, the U.S. top government infectious disease physician. Since April 2020, Dr. Fauci and his family have received multiple death threats and have required security and bodyguards. Think about it for a minute. One of the most brilliant infectious disease scientists in the U.S. receives numerous death threats from Americans due to a world pandemic originating in China. What kind of society does that?

Jacobsen: What are two great examples of American ignorance in biology/medicine and basic astronomy?

Desjardins: At my institution, we invite the best scientists in the world to talk about their research. I was privileged to attend lectures by academics who devoted their entire careers to studying American ignorance and scientific illiteracy and trying to find solutions. Here are some examples they provided. Only about 20-30% of Americans believe in the theory of evolution, the core of all biological and medical science. 25% of Americans are unaware that the Earth revolves around the Sun. More recently, when Trump recommended injecting or swallowing Clorox to kill the coronavirus during the pandemic, thousands of Americans poisoned themselves by following his advice.

Jacobsen: All this commentary around scientific illiteracy is the larger discussion around the smaller discourse of medical illiteracy. Basic facts of health and wellness disseminated to the public for public benefit generally, who, by community social police, by malevolent religious leaders, by charlatans, by hubristic greedy ignorance-mongers, and others, are lied to, about it. They’re told the opposite.

They’re told physicians, as with Dr. Fauci, for example, are agents of malevolence, even of Satan, etc. These disconnects from Ground Zero contribute to this culture of ignorance, as many other cultures. However, everything’s on camera in the United States.  

Is this a similar trend, as with the increasingly worse treatment of physicians over half of a century, of a collapse of the integrity of the proverbial social fabric and institutional trust in the United States? If so, are these mutually reinforcing trends, where, perhaps, some of the more intelligent physicians among physicians (who are already among the most average intelligent people our societies have) want to pull a House, M.D. on them (the patients)?

Desjardins: The combination of ignorance and hostility in the U.S., each reinforcing the other, leads to the current war against expertise, in which the expertise of physicians, scientists, and scholars is downplayed or wholly dismissed. I am reminded of the famous quote by Isaac Azimov: “There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that my ignorance is just as good as your knowledge.” In his 2017 book, “The Death of Expertise: The Campaign Against Established Knowledge and Why It Matters,” Tom Nichols addressed the issue. Nichols notes that “increasing numbers of laypeople lack basic knowledge, they reject fundamental rules of evidence and refuse to learn how to make a logical argument.” He describes instances where scientifically illiterate patients tell their physician why their advice is wrong. He decries Americans’ lack of critical thinking abilities, their positive hostility towards knowledge, their rejection of science, and of dispassionate rationality, which are the foundations of modern civilization.

Footnotes

[1] Academic Physician; Member, OlympIQ Society; Member, Mega Society.

[2] Individual Publication Date: May 8, 2022: http://www.in-sightpublishing.com/american-medicine-1; Full Issue Publication Date: September 1, 2022: https://in-sightpublishing.com/insight-issues/.

*High range testing (HRT) should be taken with honest skepticism grounded in the limited empirical development of the field at present, even in spite of honest and sincere efforts. If a higher general intelligence score, then the greater the variability in, and margin of error in, the general intelligence scores because of the greater rarity in the population.

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