Why Do Businesses Exist?

This past summer I had two very bright and eager student rotate through my office.  One was a health administration student in the School of Business at Winthrop University.  The other was a 3rd year medical student, who obtained an MBA prior to entering medical school.  I asked both of these students the question:  Why do businesses exist?  They both gave me the answers that they have been educated to believe are the correct answers, but neither of these students, educated in university schools of business could give me the correct and very simple answer.

As a physician, I am often told by patients that they do not want medicine to cover the symptoms, but an answer as to the cause of the symptoms.  Until one knows the cause of the symptoms, it is impossible to prescribe the proper treatment.  We are currently living in a day where widespread unemployment, economic stagnation, out of control debt and mutually exclusive political philosophies are the symptoms of a serious and life threatening disease.   If we want a solution to all of the symptoms, we need to know the underlying disease process.

Economic activity occurs as people exchange money for goods and services.  The money that people use to purchase goods and services come from one of two places.  They either earn it through their employment or it is given to them through charity or government programs.  In the first case businesses employ people and pay them for their work.  In the second case, money is given to charities and government by businesses and employed individuals in order to be distributed to those who are not employed adequately to meet their needs.  In both cases, the bottom line is that money originates with businesses.  Those business may be multibillion dollar conglomerates or a child’s lemonade stand.

If we have a sick economy, it is because there is an inadequate amount of business to generate the money required for all of the needs.  This brings us back to the original question, “why do businesses exist” for if we do not know why they exist we will be unable to create the environment in which they can prosper.

Businesses do not exist to employ people.  They do not exist to provide health insurance or other benefits to their employees.   They do not even exist to pay taxes, so the government can fund its programs.  Businesses do not even exist to produce goods and services.  Large or small, businesses exist so the owner of the business can MAKE MONEY.  Employment, benefits, taxes, charity, production of goods and services all happen on the way to a business making a profit.

When the regulatory environment becomes too onerous or fear of litigation too great or labor too expensive or tax burden too high or demand for the output too low for the owners of the businesses to make an acceptable profit, the business will disappear.  When this begins to occur on a large scale the entire economy suffer and that is what is happening in our economy today.

For a variety of reasons, it has become socially unacceptable to pursue profit in our country.  Even our business students do not want to admit it.  At one time, our country was the best place in the world for a business to prosper, but that is no longer the case.  Until we once again create an environment where making a profit is laudable and doable we will continue to have a failing economy and we will ALL be poorer for it.

That is my diagnosis and treatment for the problems plaguing our economy.

Keith Stafford, MD

What is a Doctor?

What is a doctor?  Sounds like a silly question.  It is the person one goes to see when you are sick or  want help to stay healthy.  The reality is what occurs when one sees that doctor is dependent on what that doctor thinks it means to be a doctor.  Here is what I think.

1)  A doctor is an individual who went to medical school and a residency to become a physician.  There are all kinds of ways of obtaining doctorate degrees in all sorts of fields.  I do not intend to diminish the accomplishments of those who earn doctorate degrees in various fields, but I believe when one says, I am going to see “the doctor” it should mean seeing one who has the training as noted above.  Numerous health care fields, like nurse practitioners, physical therapists and pharmacists are now awarding doctorate degrees as their standard degree.  I think this is confusing to patients and an attempt to obtain a status on par with physicians. There are many different health care providers, all with their individual and critical roles.  I disagree with the attempt to blur the lines between the different roles.

2)  A doctor has great amount of knowledge.  The education of a doctor  starts with many years of school (4 years of college, 4 years of medical school and 3+ years of residency) memorizing, learning and experiencing things that give him/her expertise in the field of medicine.  Throughout the career of a doctor, the learning never stops.  Today with the internet, it seems all one has to do is look up WebMD or Mayo Clinics and one can know as much as a doctor.  Certainly, the internet has expanded everyone’s ability to find information, but making a diagnosis or deciding on a treatment is much more involved than simply looking up a list of symptoms and there is the obvious diagnosis and treatment.   I wish it were that simple.  The fact is that human biology and behavior are far more nuanced than a simple matching of signs and symptoms.   While some things in medicine can be solved and resolved with cookbook formulas, much of it cannot and this is where the art of medicine and all those years of training and experience become so critical.  It is why a thinking doctor will never be replaced by a one size fits all computer.

3)  A doctor is a major influence.  Due to all of the education and experience a physician accumulates, society has granted physicians a significant amount of influence and authority.  That influence and authority is a great privilege and needs to be treated with even greater respect by the physicians to whom it is granted.  I sometimes wonder if many physicians are cognizant of the huge impact their words have on people.  A physician’s words and manners can be either soothing and healing or anxiety provoking and hurtful.  We doctors need to strive for the first.

4)  A doctor is an advisor.  I believe the primary role of a physician is to be an advisor.  It is my job to listen to the patient, examine as appropriate and analyze all of the available data and then render an opinion as to the appropriate course of action.  I do not get upset if a patient does not follow my advice.  It is their body and their choice.  Some doctors view themselves as THE AUTHORITY, but I believe this is the wrong approach.  There is a partnership that exists between a doctor and patient.  Each one brings things to the interaction that have to be considered.  Each patient approaches the situation from a different context.  It is not uncommon for a patient to have information of which I am not aware or had not considered.  I value this input from the patient.

5)  A doctor is a friend.  Over the years, many of my patients have become friends.  This is a wonderful aspect of being a family physician.  Whether or not I get to know a patient well enough to become a personal friend, my goal with all of my patients is to make them comfortable enough, that no matter the issue, they will be confident that my objective is to give them the same courtesy and rendering of my skills that I would give to my best friend.