A concerned glimpse into Physician and Patient Agency
In a given society, the capacity of individuals to act independently is influenced by a multitude of factors, such as social class, religion, gender, ethnicity, ability, and customs of that society. A person’s freedom merely depends on the constraints of the social structures. Frequently such an arrangement, whether intentional or a consequence of the constitutional interaction, becomes even more complicated.
The complexity by itself is a subject; frequently overlooked through widespread standards. It signifies that the common typically perceive complexity and chaos as the upshot of something or action. In fact, it is often the strategy to form an opportunity for a tiny minority against the mainstream majority. Since almost every modern society experiences the latter phenomenon in one way or another, still to the same scale, individuality and personal liberty are always subject to exploitation. To understand what I mean, we must first understand the definition of value. While at it- we must also sight the individual value within the context of the given social scenery.
The concept of Values
The values acquaint our thoughts, words, and actions. They are essential- because they help us prevail in life. Our values make the prospect we crave to endure.
Our values and beliefs reflect on the decisions we make day in and day out. Those decisions are always directed towards a specific end. All in all, the purpose of values is the well-being of individual lives or sometimes collective indigencies.
In the process of applying values towards determinations, we invariably execute purposeful choices towards what is relevant. And Meanwhile, when values partook, they build intimate coherence within a group.
Types of Values
Four types of values are described in an organizational setting: individual values, relationship values, organizational values, and societal values.
Individual values follow how one exhibits self in life, the specific needs-the principles they live by, and what we consider essential for our self-interest, such as enthusiasm, creativity, humility, and personal fulfillment.
Organizational values govern how our organization shows up and operates in the world. A few examples of organizational values include economic growth, collaboration, productivity, and strategic alliances.
Relationship values follow how a person relates to others—relationship statures such as friendship, family tree, or co-working within an organization shape Relationship values. The latter include transparency, trust, philanthropy, and caring.
Societal values ponder the way one organization reports to the community. Societal values include future generations, environmental mindfulness, science, and sustainability.
Definition of Value from a Socialist point of view
Socialists envision the necessary quality of people cooperatively. In socialism, values reflect mutual aid in striving toward a joint objective, as every part has precisely established errands. According to socialist values, constituents are valued only for their usefulness to everyone else. Thus, one in society bears a portion of the production based on how much every individual has offered.
Definition of Value from a Capitalist point of view
The capitalist culture assembles public exercises, norms, values, and habits primarily associated with the capitalist economic classification. Hence, the values in capitalism stand the reflections comprised of people bearing in harmony with a set of scholarly rules acting as they must execute to withstand in societies.
Elements of capitalist society encompass the mindset of business and corporate culture, consumerism, and working-class society.
Definition of Value from Individuality and the grassroots perspective
Individual value is an essential element of any grassroots value. It incorporates the most fundamental phase of any action or institution. Thus, for a grassroots society to entertain individual values ideally, it must incorporate Laissez-faire free-market economy.
The Laissze-Faire sees value as the reflection of its quality, uniquely based on the individual’s encounter with another within the liberated mass. The released value holds irrespective of the factors reflected through the collective societal reputation.
Agency and Nonagency
One’s agency merely implies the individual’s independent capability to behave and practice their own unfettered opportunities. Nonetheless, absolute values are the upshot of social class, religion, gender, ethnicity, ability, customs, etc. In contrast, influence determines and defines an agency and the decision based on that completed. Henceforth, The latter is commonly referred to as “nonagency.”
In a one hundred percent Laissez-faire free-market economy, Nonagency anchors the point of the human dependence on market exchange for any goods or services. The need and loss of control over crop or skill to deliver will render that soul; Nonagent. The latter bear a resemblance to a battle between individual autonomy and the values that establish an agency.
In other words, nonagency defines the social association that describes the capitalist tone of production.
In free-market capitalism, the open, transparent, and fairness of system ensures optimal harmony. However, the latter still often fail because personages participating in the crony capitalist state of associations who exert a measure of influence over their immediate surroundings often use their impact to try and tune their independence with their nonagency.
Agency in Socialist
Socialism is a populist economic and political system based on collective ownership of the means of production and delivery of service. The latter include means used to deliver goods that aim to serve human necessities directly. Therefore, irrespective of the individual, societal agency, everyone under the socialist structure would be entitled to the percentage of products and services obtained as part of the collective effort of the society. Therefore, It is fair to state that the notion of agency is of little or no value in socialism.
Agency and Nonagency in Crony Capitalism
Values are every capitalist system's means of accomplishment because it extends liberty to meet necessity on somewhat appropriately pleasing expressions. Values are accordingly most prevalent amongst the middle class and those under assistance, where the essential impact is furnished. With the lack of value impact, reconciliation between freedom and nonagency is no longer conceivable. Consequently, Values give way to different forms of normativity, like utilitarianism, service, or virtue. All of the said are presently growing exponentially.
Agency is the core of Individualism
Individualism is a sanctimonious attitude, political conception, philosophy, or social viewpoint that emphasizes the person's moral worth. Individualists are nonconformists who support the practice of one’s intentions and wishes and value independence and self-reliance. It is the individualism advocacy that interests the individual should gain priority over the state or social groups. Individualists oppose external interference upon one’s self-interests by society or institutions such as the government.
Individualism invites Laissez-faire free-market economy. Then, individual values and agency is the ultimate goal of every libertarian society.
Freedom and the Individual Agency
Freedom, also uncountable, is the state of being free, not being imprisoned or enslaved, while the agency is the capacity. It is the state of acting on free will. Despite various literal definitions given as to what agency is, however, there are many theories in existence influenced by factors such as social, cultural, and political circumstances. For example, an individual with strong religious faith grasps agency and freedom differently, as defined by the following scripture:
“Wherefore, men are free according to the flesh; and all things are given them which are expedient unto man. And they are free to choose liberty and eternal life, through the great Mediator of all men, or to choose captivity and death, according to the captivity and power of the devil; for he seeketh that all men might be miserable like unto himself (2 Nephi 2:27).”
Freedom; the Socialist perspective
Socialists, particularly concerning democratic socialism, have deployed ideals and postulates of equality, democracy, individual liberty, self-realization, with one fundamental difference. Under the socialist values, personal freedom only comes within the context of the collective determination of the community or solidarity the person lives in.
Regarding equality, social democrats believe in robust variants of the principle of balance of opportunity following broad-based equal access to the essential element and social means to live. Socialists also espouse the model of democracy that requires people to have broadly equitable entrance to the compelling ways to engage in decision-making that potentially affect their lives like a single community. Many socialists uphold democratic assistance to be available at the level of government establishments and in various economic areas like corporations.
The concept of Negative and Positive Liberty
Although Socialists are pledged to the value of individual freedom, their commitment includes variants of the standard concepts of “negative liberty” and “positive liberty” and non-domination. Socialist freedom almost always accompanies a scheme necessitating security from inappropriate intrusion by others. It trails a more critical, positive frame of self-determination as the “real freedom” of developing one’s own projects and bringing them to attainment.
Socialists often assert a sense of alliance or solidarity, according to which people should organize their economic life. In socialism, believers explain the freedom and well-being of others as intrinsically valuable. In reality, freedom marks a self’s liberty to trade and work according to their own capacities and inclinations.
Curbing the Freedom pushing for Nonagency
Controlling the capacity of individuals to act independently and make their own free choices destroys freedom and free will. By contrast, the structure is the factor of sway.
Flourishing a sense of agency requires establishing a sense of responsibility. The latest serves as one of the fundamental social functions. However, People appear to place a prize on duty.
Most, if not all, societies require that their constituents are held accountable for what they do. It has been argued that the sense of agency plays a vital part in overseeing attributions of responsibility. For others, the bearing of responsibility for one’s own actions plays an essential social function. It means that people can be held accountable for what they do, which allows behavior to be legitimately managed through punishment or reward.
Utilization of Nonagency by the rebellious Minority to harness the opportunity
Responsibility is closely interrelated to the notion of free will. Yet, the liberty of mind can be the source for establishing a chance to take advantage of complex situations to create an opportunity for a tiny minority against the mainstream popular. As I pointed out earlier in this article, the ultimate beneficiaries have been the majority and the minute minority until this point. The average minority and individuals are sacrifices of the failing system that is large, complex, and grasps freedom within a collective framework.
Patient Freedom and Agency
In typical healthcare settings, the patient agency is inconsistently interpreted and circumscribed through the literature of health information documents, the talks of physicians, and doctor-patient interaction. Patients construct their identity and act as agents in multiple forms dictated by their unique encounters within the healthcare system. Patients with an agency will manage their health conditions and, for their nonagency, would typically rely on their doctors. However, studying various data sources reveals behaviors that patient agency is realized, restricted, and that identity is often constructed in conflict with patients׳ personal perceptions of the agency. The latter is fundamentally the outcome of the socialization of medical practice and healthcare delivery.
Physician Freedom and Agency
Investigating the role of physician agency in concluding health care supply and patient outcomes suggests that an increase in healthcare supply secondary to a change in private physician influences may have a vague impact on patient well-being. The growth can indicate either provoked interest for ineffective care or a decrease in prior rationing of adequate care. Moreover, the physician market structure is crucial in devising the beneficial consequences of variations in private physician enticements. It was found that this surge in treatment enhanced patient survival, extending the median life expectancy for lung cancer patients by nearly 18%.
Some data illustrates the variation between patients׳ acting agencies and healthcare professionals׳ directed agency as submissiveness. Therefore, it is imperative to realize that Physician freedom and agency considering the constant positive attitude towards establishing personalized healthcare through patient engagement, we are still far from achieving one. Because; the healthcare system under the current notion of population health and socialized medicine is oblivious of the actual patient self-agency. Additionally, the current medical service delivery system is riddled with complexity, an intolerant small minority, and highly negative liberty within the expanse of physician and patient interactions inside the healthcare systems.
To further elaborate, I would like to end this writing with a few References:
Restraining Independent Medical Practice through Healthcare reimbursement Market
External factors creating nonagency such as reduced competition among clinicians have led to higher prices for health care services. It has reduced choice and negatively impacted overall health care quality and the efficient allocation of resources. Government policies have stifled competition by subduing the available supply of providers and restricting the range of services.
Health Care Provider Markets were restricted by State orders that limited admission. Hence, it has suffocated innovative and more cost-effective ways to provide care while limiting choice and competition. The policies have resulted in fewer grounds for providers to improve quality. Health Care Insurance Markets and Government mandates have reduced selection and competition in insurance runs and grew overall premiums.
The health care system’s extreme dependence on third-party payment insulates consumers from the actual cost of healthcare. It also extends them little incentive to search for low-cost, high-quality care.
Containing Individual reign by way Medication Market
Similar to the insurance industry; Changes in drug life cycles have dramatically affected patent medicine markets, which have long been contemplated as a self-evident and self-sustainable source of income for highly flourishing drug corporations. In combination with high merger and acquisition exercises in the pharma sector, market failure has allowed price increases for even off-patent drugs. With market interventions in health care, governments have examined to regulate drug prices but have encountered failures.
Intentional changes in drug life-cycle dynamics have created a fertile ground for high-priced drugs, the unintended effects of patent legislation, government policy measures, and orphan drug programs.
Curbing the Scientific mind through Licensing and Certification Monopoly
The concept of licensing and certification was created based on the fairness of building quality professional standards for goods and services rendered by selves entities. However, over the last century practice of licensing has evolved into a refined procedure; in many aspects, it had scarcely to do with quality but more to do with control and power of jurisdiction over the intellectual minds.
The practice of aggressive licensing has merely extended to other careers, practically to those not presenting any direct risk to society. Yet, it also has stretched the expanse of its interference for a limited reason.
For the authorities to restrain the influence of intellectuals, they have uncovered an efficient process by which they have been able to control its genius through accreditation and privileging those tied through political and monopolistic alliances.
Occupational Licensing remains “the modern pseudo-monarchist aptitude” above its intelligent subjects. It serves as a well-executed resource that redirects the economic interests and productivity inspired by the magnificent talents away from its cradle into the streams of chosen personalities, factions, and entities.
Semantic shift as the invisible harness to the open mind
Today, the most maximum political and administrative display proceeds ahead of merely dysfunctional statesmanship. Instead, it heals as ruthlessly fabricated checks are executed behind the presentations of the performance. Societal Scenery is riddled with the distracting and disingenuous curtain of political theatrics exercising redefinition of the popular expressions.
It is proof of the leverage of the democratic principle that autocratic executives worldwide privilege the mask of emancipation for forms of government that sponsor legalized oppression.
Semantic shift on democracy is the modern way the control the civic. Be it intentional, coincidental, or outcome of societal engineering, the asynchrony between definitions, the meaning public perception of any catchword is evident. That is delicate territory for any term provided the point of time and place. It serves as a perfect environment riddled with rarefaction of opportunity benefiting the emulators. Over time, semantic shift extends an abundance of alleys and clearly defined client touch-points, label identity, and drastic ingenuity that adds the highest value to corporations.
The Good, The Bad, and the Ugly of Quality Measures
Recently, healthcare in the USA and other countries alike has undergone cumbersome policy and business transformation. To meet the new criteria, the industry has begun to examine new quality metrics or key performance indicators (KPIs). But, the latter KPIs are generated by non-medical entities like corporations and insurance companies. The corporate system uses cookie-cutter protocols focused on maximizing financial return.
Quality is typically measured against something comparable. The concept of similarity is only relevant to the patient’s expectation and the physician’s expertise. Numerous variables account for the quality measures on individual medical practice and are unique to every physician.
Quality must be determined within explicit terms or metrics, as it cannot be something symbolic. It enables physicians to translate patient needs into measurable goals. It is always important to define a set of quality metrics while organizing to know what exactly requires to be fulfilled. But, it is unfair, nevertheless counterproductive to physicians and the patients, if mandatory non-medical actualities develop quality measures. The one-size-fits-all recipe is non-applicable to healthcare and only fits insurance companies and the big data industry.
Devaluation of the real Values to shifting Semantics of Personalized Healthcare
“It is more important to know what sort of person has a disease than what sort of disease a person has.” — Hippocrates.
Parallel to what I previously pointed out with reverence to societal engineering, semantic shift, and quality metrics, value has not been unaffected by the negative liberty. Indeed, what truly defines the actual service cost, particularly within the healthcare realm, is very controversial.
For the past three centuries, we have encountered remarkable progress in technology, scientific awareness. Parallelly, we have also observed increasing expectations of the Millennials in all aspects of human life, including healthcare. We have seen many attempts to adapt to the situation with little headway tendered. The failure can be bound to the inadequate and contradictory definition of quality and value. We are striving to meet the criteria of optimal healthcare based on the popular. Concomitantly, we neglect the variables that utterly fail to entertain arithmetical measures. Thus, sadly, public attention is being distracted from the actual definition of value and personalization.
The contemporary solutions are enduringly devising a hybrid redaction of the original system. It doesn’t recognize that the value of healthcare and human life is a measure of the quality of care sensed subjectively by the patient. And the fact that subjective valuation is in line with the care provided through objective evaluation of the treating physician at a particular point of time and place. Instead, we are following the guidelines developed based on profiling specific traits and predetermined qualities. Henceforth, we cannot deliver quality healthcare with actual values because we lack a concrete definition to begin with!
We can refer to the recent efforts by the Department of Health and Human Services (HHS) concerning implementing value-based transformation to primary care medicine. The up-to-date is the epitome of the government’s way of providing an incentive that only sinks as far as the rhetoric by title. All it holds is the means of deception using:
The citation inclines Profile physicians irrespective of their independent skills and qualifications.
It erroneously assigns a non-clinical image of Primary care as a subspecialty
It assumes lean value-based billing practice is, in fact, the quality medical practice
Its rationale for quality care and the value of service is vague and irrelevant.
Promoting selective lower administrative burden as the reward in compensation for increased end value of rendered corporate care
Enabling primary care practice is as evenhanded as empowering the physician within a particular system.
It concentrates on limited patient Empowerment with utter disregard for physician commitment.
The policy is portraying chronic complex medical problems underneath the scope of general medical practice.
It fails to describe the accurate meaning of quality and value of delivered medical service.
It fails to observe the individual determinants of the quality and value in solitary patient care.
Economic Rent and domination over the real Value
Economic Rent has become an Influential tool to limit Talent and Skill. It has enabled governments and many corporate entities to adjust the payment of production over the costs needed to bring that factor into production whenever monopolistic wise necessary. For instance, the Disparity between quality; and quantity of work and how much a person earns is notable across a multitude of labor markets. In 2010, the foundation of economic equality cast light on the latest era healthcare monopoly by characterizing it as merely the derivative of “artificial inflationary forces.”
To organize a high deserving of deliverable proportionality, organizations, including the governments, have adopted mechanisms and policies to penuche the business Nikkei.
Government intrusion has been utterly fundamental to see the legato fluctuation of the workforce.
Licensing, certification, and even re-certification have been historically employed to exploit who can and cannot complete given assignments. In opposition to the impressionable work market where every person can receive skills and apply without preconception, the close job market is rigorously controlled.
A closed system is basically allocated for the formally selected supreme faction of citizens affiliated with conventional pink labeled standards.
Complexity as the ultimate weapon over Transparency and Accountability
The linguistic context of signifying as straightforward to understand and perform is a phenomenon familiar to every person. We all have embraced our share of standing in such a position that we had to overcome complicated impediments.
“Simplicity is the key to success over hardship. It is the point where our solutions prevail over the complexity”.
The strategy is the plan of simplification, and the complexity of human life is the light of personal attitude towards the healthcare provided. Medical science is just as expansive as the human body and soul. It is complex, not only due to its physical dimensions but due to its constant underlying emotional, social, spiritual modifiers.
Nevertheless, the main idea behind complexity is that the organization functions unpredictably to its grassroots elements. In the complex system, the interplays weigh more than the character of the members. Hence, complexity serves as a preferred framework of the status quo for many factions.
Crony Capitalism as the Tactics to suppress Individual disposition
Expected By virtue, socialism only recognizes human individuality within the collective context. The prevailing trend is that the majority of the world’s economic system is following business models that flourish not as a consequence of risk but somewhat as a yield on money amassed through a series of interactions between a business class and the political class. Crony capitalism holds prevalent disregard for individual disposition. It has served as a target for the leftwing liberals and was cast off by reformers without yielding for what pure free-market capitalism stands.
The populous posture today is the determinant of the ruling attitude towards socialism and capitalism. Within the continuation, individuals fall within the classification of most social-oriented habitants. Despite remarkable societal integrity, humans have frequently failed to recognize one basic notion: individual diversity and the contrast between personal and social importance.
Using Verticalized knowledge to hinder the expansion of Global wisdom
We live in a system of occupational profiling. The thought of classifying skills and knowledge organized on the distinct outline is hardly a circumstance of convenience. Besides, the new abilities were invented, as the new job titles are formed in conformity to support restricting the sovereignty of intellect.
The ranking of skillset is a useful instrument under particular circumstances and requisitions. It tends to streamline the strategy to meet one specific arrangement or make something productive. Any utility beyond that is ineffectual to any legitimate motive. However, profiling is prejudiced in every shade and style, thus must be avoided if deemed excessive. About knowledge, Bundling becomes redundant, as is our skills and ability. The commission of title has perpetually been the agent of monopoly and baseness. It has been adopted by licensing systems with the rationale of public safety and quality of service. I call it- It’s All about regulating the economy, job market, and pay.
In the modern scientific world, intelligence is the disciple of the nod played out by people with dominance over the civic mindset. The aftereffect holds an uneven allocation of opportunity, labor market, environment, and stake.
Medical Societies and their flop over Physicians
The American public has noticed the American Medical Association’s (AMA) failures to uphold its obligations. Contrary to what’s declared to represent as the champion of the interests and values of the country’s doctors and patients, AMA has utterly been the public depiction embellishment of the private health insurance system in the US. Today corporate medicine is, in fact, being sold to the public by the AMA. That includes the American Hospital Association (AHA), health maintenance organizations (HMO), Private insurance companies like United health care and Amazon.
Today's healthcare system is the sacrifice of the ambiguous viewpoint of medical societies and associations contaminating the essence of medical education, the medical establishment, physician mission through a three-century-old pseudo-utilitarian theory. The association is taking advantage of patient and physician vulnerability over unsustainable underhanded protocols, procedures. The modern fragmented yet outmoded system encompasses the ruined rotted framework to entertain normal execution of the initially vowed commission, thus potentially serving as the cutting edge for their bent march.
The Personification of the Corporation as a way to dehumanize a soul
A corporation is a person with the collective dynamism of a large group. The legal identification as an individual has granted corporations safe harbor, including all the prerogatives primarily exercised by human beings. This advantage attends well on top of the previously fixed consolidated financial and political influences that are barely within range by a person. The invented Legal personality upheld by corporations was to ensure the path for even more assuring efforts.
Corporations are a master invention of persons pondered to guarantee the gain of their patrons, irrespective of their effort outgrowth to the community.
Extreme application of Protocols used beyond Standardization
The standardization method is the way to micro-manage an autocratically inclined administration system where the majority of the processes constitute a dull but rigid top-down reflection of the ranked approach to what central command intends to dictate. Application of the Standard Operating Procedure (SOP) and protocols in healthcare is an intricate state. If applied broadly would more likely have a paradoxical upshot. With the adoption of Protocols on a large scale, the outcome would bureaucratize the medical practice.
Agency, Medicine and Individuality: The take-home Message
Patients and physicians are all individuals. An Individual’s agency is one’s independent capacity to act on their will. This ability is affected by the cognitive creed arrangement which one has accumulated through one’s experiences and the values held by the individual in a society.
In the sovereign state, a patient and doctor independently interact with their surroundings within the healthcare system. Their nonagency under sovereignty is the reflection of the actual ability in exchange for freedom. Henceforth, Disagreements on the extent of the doctor or patient’s agency often are grounds for conflict between parties. The latter includes colleagues, patients, and doctors, and stakeholders.
The major issue is that current systems invites complexity, chaos through collectivism and populist attitudes. The complexity ensues when there is a battle of majority populist and smallest minority rebel. The dictation of the majority is typically overturned via the rebelliousness of few minorities for the latter's benefit. The benefit to the minority is merely the product of projected triviality through the illusion of propagation to the majority. It means that under the prevailing system, the dominion of the rare rich and powerful predominates the system under the umbrella of the mainstream majority at the price of individual autonomy (Patients and physicians).
The irony remains- the process never ends, as the vicious circle of fueling populist response and rebelliousness of the minority will continue until true “positive liberty” and the laissez-faire market economy are recognized.
Originally published at https://www.datadriveninvestor.com on May 14, 2020.