"First Do No Harm"
Healthcare's mission statement has fallen by the wayside, and the eventual fallout will be cataclysmic...
Read time: Approx 5 mins
Once upon a time—not in a fairytale but in Ancient Greece—there lived a man named Hippocrates who believed medicine was a sacred trust. His oath, a guiding light for physicians for over two millennia, begins with a solemn command: First, do no harm. But as anyone who’s ever disputed a medical bill knows, in modern American healthcare, that principle has been given a rather sinister remix: First, secure the funding.
What was once a sacred promise has become a marketing tagline…
When Life Comes With a Price Tag
The dystopian choice between bankruptcy and death is no longer the plot of speculative fiction—it’s reality. I’ve seen patients decline chemotherapy because they feared the five-figure deductibles more than the disease. One man, a veteran no less, opted to amputate a diabetic toe himself rather than incur ER costs. A woman in her thirties rationed her insulin and died quietly in her sleep. Her GoFundMe still lingers online, a digital headstone shaped like a donation box.
But, sure…let's keep pretending we're okay :).
The Rise of the Healthcare-Industrial Complex
In the U.S., healthcare is the third-largest industry by GDP, clocking in at nearly $4.5 trillion a year. With that much cash on the table, altruism gets smothered under spreadsheets. Hospital administrators earn seven-figure salaries while ER nurses skip bathroom breaks. Insurance giants boast record quarterly profits while patients wait months for pre-authorization. If Socrates were alive today, he’d probably be stuck on hold with a billing agent in Bangladesh.
Look no further than the absurdity of coding—a labyrinthine process that turns every sneeze and stethoscope glance into a monetizable event. It’s not uncommon for a doctor to spend more time coding a patient visit than actually seeing the patient. Because in this economy, care is secondary to documentation.
**Patients: Please note that, as we providers, we absolutely LOATH this part of healthcare, as well. We are, sadly, also forced into playing the game to survive…
Emergency Rooms: America’s Patchwork Safety Net
The ER has become the duct tape on the gaping wounds of a failing society. It’s the only open door for the homeless, the uninsured, the addicted, and the abandoned. Police often drop off people with psychiatric crises not at clinics but at ERs, where a security guard and a gurney await. I've witnessed patients detoxing under fluorescent lights, their pain met with protocols rather than presence.
And yet, the ER is arguably the worst place for complex social and psychological ailments. It is loud, chaotic, and designed for physical emergencies—not for healing trauma. We discharge patients back to the streets with a bus token and a vague suggestion to “follow up.” It’s like putting a Band-Aid on a bullet wound and calling it care.
Fragmented Medicine: Treating Organs, Not Humans
Modern Western medicine excels at one thing: dividing the body into billable units. Cardiologists rarely speak with endocrinologists, psychiatrists avoid dermatologists like the plague, and the result is a whack-a-mole approach to chronic illness. High blood pressure? Here’s a pill. Depression? Take another. Stomach upset from the meds? Here’s a third. Passed out from the combined side effects? Go to the ER. Gaslit from the whole process? Psychiatry can help.
We’ve become dependent on pharmacological life support systems that manage symptoms while ignoring cause. And let’s be honest—there’s little financial incentive to cure someone when managing their condition brings in a steady stream of revenue.
It's no accident that the average American is now on four prescription drugs by age 50. We’re not healing—we're sedating.
Dependency as a Business Model
Chronic disease is the golden goose of Western medicine. Diabetes, hypertension, arthritis, COPD, obesity—all incredibly manageable, none especially curable without, first, demolishing our sinister societal values. We've constructed a system where wellness is elusive by design, and dependency is the recurring revenue stream.
It’s not just cruel; it’s absurd. Imagine designing a fire department that profits only when buildings keep burning. That’s our healthcare model—arsonists running the fire brigade.
The Co-Dependent Spiral: When Every Ache Demands a Diagnosis
But we must also, with compassion and clarity, look in the mirror. The crisis of healthcare isn't only imposed from the top down—it’s reinforced from the bottom up. We've created a cultural dependency, a narrative where every discomfort becomes a medical emergency, every feeling of fatigue a symptom worth diagnosing. We’ve grown anxious in the face of ambiguity, allergic to not knowing. And in our desperation for clarity, we’ve outsourced our discomfort to white coats, pills, and now even AI.
It’s not uncommon anymore to see someone search their headache on Google, read a terrifying differential diagnosis from a medical subreddit, ask ChatGPT if they might have a brain tumor, and then panic-drive to the ER—convinced the end is near. The irony is not lost: in seeking reassurance, we’ve created more fear, more visits, more interventions, more cost.
Our culture has quietly medicalized being human. Feel sad for two days? You must need medication. Lose your appetite during a breakup? Better get a GI workup. Sleep less when stressed? Maybe it's early-onset insomnia. We’ve come to expect quick fixes for slow-burning, existential questions.
None of this is to shame patients. When we live in a constant state of fear and scarcity, everything feels like too much. It’s human to reach for a life raft…but the Healthcare system should not be the entity responsible for solving every shortcoming in our broken society…The world has become increasingly complex and atomized; healthcare is often one of the few remaining institutions where people can dedicate a sliver of time towards being heard, seen, even temporarily held. But the unintended side effect of turning every fluctuation of the human experience into a medical case has fueled an unsustainable demand for services.
Ozempic Nation: The Allure and the Omission
Take GLP-1 receptor agonists—medications like Ozempic, Wegovy, and Zepbound—as a prime example. These drugs have revolutionized weight loss and glycemic control, no question. For many, they are life-changing, helping patients shed pounds, improve metabolic profiles, and regain mobility. But the rollout has been as reckless as it is rapid.
Patients often begin these regimens with minimal education. Few are told that rapid weight loss can cause gallstones. Even fewer are prepared for the psychological implications—disordered eating patterns, body image distortions, or the disorientation that comes from losing one’s identity as an “overweight person.” And the moment they stop taking the drug, in the absence of dietary, behavioral, and psychological scaffolding, the weight often returns.
We’ve handed people an ejector seat without showing them how to land.
This isn’t just a failure of individual clinicians—it’s systemic. These medications are designed for chronic use, not for holistic transformation. Because healing people would be less profitable than managing them indefinitely.
The Compassion Deficit
There is a moral decay beneath the procedural polish. We've lost the capacity to see one another. Providers, battered by bureaucracy and burnout, begin to see patients as problems, not people. Patients, disillusioned by denial letters and robotic care, begin to see doctors as obstacles, not allies.
Litigation has sharpened the divide. In a country where a missed diagnosis can bankrupt a hospital, every exam becomes a liability audit. We don’t ask “What does this patient need?” but rather, “What can I do to avoid being sued?” Cue the barrage of CT scans, blood panels, and referrals—not always because they’re needed, but because they provide a paper trail.
This defensive medicine doesn’t just balloon costs—it erodes trust. Patients begin to suspect they’re being over-tested, over-treated, and under-cared for. They’re not wrong.
International Contrast: Less Fear, More Care
In most developed nations, the ER is a place of efficiency and calm. I once shadowed an ER physician who had previously practiced in Stockholm—”Six hours, twelve patients, one CT scan.” The default assumption was that patients were telling the truth and the doctors knew what they were doing. In the U.S., every complaint is a potential lawsuit, every patient a potential adversary.
It’s exhausting. And expensive. And it’s breaking us.
What Needs to Change
This is not an unsolvable problem. But we can’t reform it by tweaking around the edges. We need bold, structural shifts:
Universal Access: Healthcare is not a luxury. It's a societal responsibility.
Integrated Services: Medicine should collaborate with housing, education, and nutrition sectors—not serve as their underfunded substitute.
Legal Reform: Protect patients without turning physicians into defendants.
Holistic Models: We need to start treating people—not just their lab results…And no that does not mean turning to the supplement-pushing, “just want to check my vitamin levels” BS that is equally plaguing the chiropractic and naturopathic spaces.
Cultural Reset: We must relearn the difference between healing and fixing.
Conclusion: Towards a More Human Medicine
The road back to compassion starts with remembering that health is not a commodity. It's a human right. The system we’ve built—layered with red tape, bloated with profit motives, and starved of empathy—is unsustainable. And it is harming all of us. There is no world where profit and true human-centered care can co-exist. And if the argument is that direct primary care is the answer…well that's equally short-sighted. Because the most vulnerable, impoverished patients will always be left on the sidelines.
Medicine needs a reckoning. Not just financially, but spiritually. Because when a society lets its sick choose between medicine and meals, we’ve all taken an oath—not of healing, but of collective neglect.
It’s time we remembered the original promise: First, do no harm.
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This is a great concept for a substack. I look forward to watching you grow. I will be your 16th subscriber :)
Great read Dan. Subscribed!