The Nature of Suffering, Health Care "Providers," and the Opioid Crisis.

Over the past 40 years, American medicine has become corporatized. Medical care has become permeated by a business philosophy whose primary concern is increasing shareholder value rather than providing optimal care for patients. Patient-physician relationships have eroded as the health care system has turned its attention toward electronic medical records (rather than face-to-face interactions with patients), toward quantifiable ("billable") metrics, and toward calculating the relative value units delivered by various health care "providers." An emphasis on clinical efficiency has diminished the depth of patient-physician contacts and has tended to promote quick, superficial interactions. Patients in pain are often overmedicated rather than listened to and understood. Suffering (which is at bottom a problem about the meaning of illness) has lost its place as a major medical concern. It is often easier to write a prescription for a powerful narcotic than to probe the details of a patient's life. This unfortunate tendency to seek quick, pill-based solutions to pain has been reinforced by the pharmaceutical industry, which has promoted this simple but profitable approach through the aggressive marketing of oxycodone and related medications. Both patients and physicians have lost out in the process. We need to reconstruct a health care system that gives pain its due but places that pain in the larger context of a patient's suffering. This can only be done by restoring clinicians to their preeminent place in medicine. We must strive to be healers, not simply providers.