Fire your stockbroker, fire your doctor

Is it yet time to fire your doctor?

I advocate a model of self-directed health, a style of healthcare in which individuals have the right to direct his or her own healthcare with only the occasional assistance of a physician or healthcare provider.

Healthcare would not be the first industry that converted to such a self-directed model. Remember travel agents? Only 15 years ago, making travel plans meant calling your travel agent to book your arrangements. This was a flawed system, because they worked on commission, thereby impairing incentive to search for the best prices. You were, in effect, at their mercy.

The investment industry is another such example, though on a larger scale.

Up until the 1980s, individual investment was managed by a stockbroker or other money manager. Stockbrokers, analysts, and investment houses commanded the flow of investment in stocks, options, futures, commodities, etc. Individuals lacked access to the methods and knowledge that allowed them to manage their own portfolios. Individuals had no choice but to engage the services of a professional investor. This was also a flawed system. Like travel agents, stockbrokers worked on commission. We've all heard horror stories in which stockbrokers churned accounts, making thousands of dollars in commissions while their clients' portfolios shrunk.

That has all changed.

Today, the process has largely converted to discount brokers and online services used by individuals trading and managing their own portfolios. Stockbrokers and investment houses continue, of course, but are competing for a shrinking piece of the individual investment market. Independent investors now have access to investment tools that didn’t even exist 20 years ago. Companies like E-Trade and Ameritrade now command annual revenues of approximately $2 billion each.

Travel agents, stockbrokers . . . is healthcare next? Can we convert from the paternalistic, “I’m-the-doctor, you’re the patient” relationship to what in which you self-direct your own healthcare and turn to the healthcare system only in unique situations?

I believe that the same revolution that shook the investment industry in the 1980s will seize healthcare in the future. In fact, the transition to self-directed health will dwarf its investing counterpart. It will ripple more broadly through the fabric of American life. Health is a more complicated “product,” with more complex modes of delivery, and more varied levels of need than the investment industry.

I predict that the emergence of health directed by the individual, just as the emergence of self-directed investment, will dominate in the coming years.

While I hope you've already fired your stockbroker, and I doubt that anyone on the internet still uses a travel agent, I wouldn't yet fire your doctor altogether. But I believe that we are approaching a time in which you should begin to take control over your own health and begin to reduce reliance on doctors, drugs, and hospitals.

Comments (10) -

  • Jenny

    4/11/2009 3:04:00 PM |

    The problem with the concept of "self-directed health" is how ignorant most people are about health in the general population. The online community is self-selected and we are extremely well read and aware.

    But I have friends and even family who have medical conditions but know nothing about physiology and  have no interest in learning about it.

    My belief is that most people don't develop an interest in self-directed medicine until, like myself, they or a family member have been seriously hurt by a doctor they trusted. Until that happens most people will trust their doctors.  Sadly, for many of them the "seriously hurt" translates into "Unnecessary first and fatal heart attack."

  • Anonymous

    4/11/2009 3:19:00 PM |

    I would love to utilize the "a la carte" menu of healthcare model... in fact in many ways I already do.

    Hopefully the next thing to go will be the horrified looks... as if I am endangering my health by directing my care, for asking for tests or services when they are needed, for refusing to be a drug company research subject or pawn, and for being as informed about my body and about medicine as I can be.

    Yes, it is definitely time... but this model only works for those who are informed, aware and proactive.  Those who are too timid, or intellectually challenged, or lazy to direct their own care, will prefer the status quo.


  • Anonymous

    4/11/2009 3:26:00 PM |

    I agree with your assessment. Unfortunately, there are many who believe that a national health care bureaucracy is the "answer." If this comes to pass, we will all be paying twice for our care: once for the bloated and ineffective system (just look at our public schools) and once for our self-directed care.

    Thanks for spreading the news.

  • Brock Cusick

    4/11/2009 6:15:00 PM |

    Speaking as someone in the "Investment Adviser" business, I can say with great certainty that Ameritrade and Charles Schwab can give people the ability to make stock trades cheaply, but they cannot help them (much) make trades wisely.  Main Street Joe has gained incredible ability, but expertise lags considerably.

    Most importantly, expertise will ALWAYS be lacking because (if Joe is doing his job) he spends most of his learning time on his real job, whether that's carpentry, plumbing, doctoring, or whatever. The guy who looks at stocks professionally will always have a better feel for the market and what makes a good stock.

    The solution isn't to fire the investment adviser (aka, the expert), but to change the incentives. Get rid of the commission. Fee-based advisers (who take a fee determined by the total assets under management) have the same incentive as the investor - to grow the value of the portfolio.


    We can make an analogy to Doctors. If the General Practitioner acted more like a Health Adviser who got paid only when you get healthy (rather than get paid when they sell you a medication or procedure) I bet we'd see radical improvement in care. There would probably also have to be payments in the event that the patient refuses to comply with taking his vitamins or stop eating bad things.

  • Lena

    4/12/2009 1:20:00 AM |

    I'd love for this to hurry up and be the case. My current GP always seems "concerned" if I try to take a detailed interest in my own health, as if I am a hypochondriac. I'm quite good at reading body language and am not a paranoia-prone person, so I don't think I'm misreading the situation. She got upset when I brought in some information relevant to my case because it had come from the internet. It wasn't even anonymous, dubious information, it was a guideline authored by two eminent professors in the subject which was widely linked to by medical professionals. But because it came from the internet it was somehow invalid.

    There will be some doctors that will fight tooth and nail before they give up their paternalistic doctor-is-god ways.

  • Dr. William Davis

    4/12/2009 1:11:00 PM |

    Good thoughts, all.

    The fact that we are even having this conversation online is testimony to the fact that self-directed health is ALREADY happening. It is not some sci-fi figment of imagination. It is happening, it will happen, it will grow.

    Granted, "only" 5-10% of the population (15-30 million) will, in the next 30 years, participate. That should not stop one of the most exciting, revolutionary steps in healthcare to develop.

  • Trinkwasser

    4/12/2009 2:29:00 PM |

    Fully agreed! Yes there are a lot of cranks on the internet but equally there are a lot of people pointing and yelling "Crank!"

    This does NOT happen with your GP who might actually know very little about your specific condition, and that knowledge may be 50 years out of date. Sadly this is likely to be the case if he (or you) inform yourself from some of the woefully inadequate "professional" sites.

    Many doctors are first class, as are many other sources of health information. Increasingly we are seeing first class patients also! Teamwork is the best plan, my GP has pointed me to information I didn't otherwise know, and I've returned the compliment.

  • Kris

    4/12/2009 6:51:00 PM |

    it reminds me of speed limits on our Highways. where many people can safely drive at 100 miles an hour but not every one is capable of doing it. Therefore speed limits needed where majority is expected to drive safely. The concept of "self directed health" runs in to the same danger. even though i my self, treated my misery by self educating after years of appointments with doctors and not only suffering physically but also paying big price socially and economically. It is  important to change the selection process of these so called doctors before an individual is allowed in to a medical school. the selection should be based on not only academic achievements but a real personality for community service without ego should be a major criteria. A doctor's inability to treat patient accurately effects our social life and community at large. i still believe that more doctors are sick themselves and therefore are blinded by the false ego. Most don't have the stomach to Liston to their patients. general public shouldn't have to waist their time learning "self directed health treatments". we have a system in place and there are people being trained to take care of the society. it is the selection and training of these individuals which needs an over haul which will require some major alligators/licensing authorities  in the medical system to be shaken.
    However, since internet is a useful tool for learning and millions are already using it for self diagnoses, The medical language (studies and trials findings)posted on the internet should be in plain English so that misunderstanding can be reduced for general public.

  • Anonymous

    5/4/2009 3:53:00 AM |

    Emancipated Patients and a New Kind of Doctor

  • Jessica

    5/6/2009 9:27:00 PM |

    Our medical director (and Vitamin D proponent) calls this concept "Medical Self Reliance."