A colleague, knowing of my academic work in medical history and doctor-patient relationships, shared with me her experience this past fall. A senior in her 70s, she is an insulin-dependent diabetic who, through no fault of her own, stopped receiving her regular three-month supply of injectable insulin from Caremark, her Medicare drug plan. In early September, she searched in vain for the next box of syringes, but, to her surprise, the refrigerator storage drawer was empty.
What happened? Louise ran out of insulin for two reasons: (1) Caremark, for some inexplicable reason, held up her usual shipment of insulin because the accompanying box of 100 needles, an entry-level Caremark employee decided, should perhaps be reduced to 90 needles. The impossibly trivial difference between 90 and 100 needles – N.B., the prescribed box of needles came in boxes of 100 – put the shipment of insulin on hold; (2) The office staff of the prescribing endocrinologist, as reported by Caremark representatives, neglected to respond to emails and faxes requesting clarification of needle numbers (viz.,“Yes, she always gets the box of 100 BD ultra-fine short pen needles.”). So a three-month supply of life-saving insulin, bundled with the box of needles, was placed on indefinite hold.
My friend’s local pharmacy agreed to provide her with a short-term supply of insulin, so she was not desperate, albeit anxious to reestablish the normal supply line of insulin and needles she had been receiving for many years. The pharmacy, with only a single box of insulin on hand, would not order more to complete the current prescription. So early the next morning, her husband went to the endocrinology office, explained the situation, and requested a new script from his wife’s physician. He added that the local pharmacy had provided the single box of insulin it had on hand, and would not reorder more to complete the current refill. Caremark insisted on a new script from the physician to reestablish the usual supply of insulin and needles.
Several days passed, and despite the trip to the office requesting a new script, nothing happened. Another several days passed, and Caremark finally informed Louise that a new script for Louise’s insulin had finally come in, but it called for a 267-day supply of insulin and could obviously not be filled. What was going on at the endocrinology office? Additional complications ensued.
Jump forward several more days, with the matter still unresolved and the endocrinology office staff incommunicado. So on 16 September, Louise calls the office three times, requesting each time that her physician kindly return her call on that day, as she needed to speak with him about a pressing matter. But her calls elicited no response, neither from her provider nor from another provider. Nor did the physician make contact via the patient portal, as he had in the past. Louise had become, in the language of malpractice law, an abandoned patient.
Another four days pass, and Louise tried reaching her physician on the health plan patient portal. Now, finally, he responds, albeit briefly. He regrets the situation and adds that a person from the health plan’s patient relations department was to have looked into the issue and been in touch with her. But at the time of this portal message, four days after contacting the office repeatedly by phone, Louise had not been contacted by anyone else from the health plan’s Patient Relations Department.
Now, however, no doubt prompted by the physician’s renewed contact, Louise finally received a call from a young Ms. Jones from the health plan’s patient relations staff. She began, lamely, by noting that she had indeed placed a call earlier in the week but, on reflection, realized her call may not have gone through owing to installation of her department’s new phone system. She then noted “possibly” inappropriate behavior on the part of Louise, adding that patient relations would be meeting with the endocrinology office staff to discuss the matter. She did not specify the allegation of “inappropriate” behavior, nor did she explain why she had not tried to call Louise again earlier in the week after her department’s new phone system was up and running. The matter that had prompted Louise’s calls to the office and the physician’s failure to return her calls or subsequently contact her elicited no comment.
As it turned out, Ms. Jones had contacted the physician four days earlier, advising her not to contact Louise. At the time, she was ignorant both of Louise’s predicament and of the range of issues she needed to discuss with her physician. Yet, she – a lay person who would only contact the patient four days later – was comfortable intruding herself into the doctor-patient relationship, ignorant of the issues that led Louise to place three phone calls about a very important matter. Obviously, a patient’s need for reassuring contact with her physician was lost on her.
Four days later, following Ms. Jones’s belated and accusatory phone call, Louis received a letter, no doubt from Ms. Jones (“I have tried reaching out to you”), but with the generic “patient relations department” as sole signatory. The letter proceeded to accuse Louise, without any specifying of particulars, of both “inappropriate” and “disruptive” behavior. The second paragraph asserted the health plan’s commitment to a safe environment for its employees and providers – though not for patients’ well-being – and closed with an ominous warning: “Any further disruptive behavior could result in your discharge from this office.”
What do we have here? A patient is threatened with expulsion from her physician’s office, thereby denied medical care, because she called the office three times on a single day (morning, mid-day, and closing time,) requesting each time that her physician return her call. Apparently, in some preternatural way, these brief phone calls, which stressed the patient’s need to speak with a physician, impeded the work flow of the office. The letter of rebuke, which elided the particulars of the situation, made no mention of reciprocity, of the obligation of physicians and office staffs to be responsive to patients’ needs, especially patients who reach out in distress. Taking the signatory of the letter at face value, Louise stood accused of “disruptive behavior” by a “patient relations” department that was uncomprehending of the relationality that subtends doctor-patient-office staff interactions – especially interactions that bear on pressing matters that range beyond the routine scheduling of appointments.
Reaching out directly to the health plan’s patient relations department in the wake of this letter, Louise eventually received a call-back from the department manager, who at long last set the record straight once and for all. The office of the physician in question, with his approval, had lodged a formal complaint against her. To which the manager, added, with finality, that Louise was apparently “behaviorally disturbed.” But there had been no “behavior” of any kind on Louise’s part. She simply made three brief phone calls, requesting each time that her physician return her call to discuss insulin supply and other medical matters.
Certainly, Louise evinced mounting exasperation owing to her physician’s failure to return phone calls characterized as semi-urgent; in a moment of candor, the patient relations manager admitted she would have felt exactly the same way as Louise. By the third phone call at day’s end, it was clear to her that no one from the endocrinology office – much less the physician himself – would return her calls. Did Louise sound exasperated and, by the third call, angry? You bet. But at no point during any of the calls did she raise her voice, use inappropriate language, or lose her temper.
And now for the punchline. There is no Louise. The patient in question is yours truly, Paul Stepansky, creator of “Medicine, Health, and History.” The healthcare plan in question is Summit Health, now owned by VillageMD, one of the largest independent provider groups in the U.S. It acquired Summit Health in January 2023 for $8.9 billion. Two years earlier, in 2021, Walgreens Boots Alliance paid over $6 billion for a majority stake in VillageMD. Did the investment pay off? In the second fiscal quarter of 2024, Walgreens reported a net loss of $5.9 billion related to VillageMD. What it dubbed, euphemistically, an “impairment charge,” resulted in the closure of 160 VillageMD primary care clinics, all victims of a fiscal reality that belied corporate insistence, via a histrionic chorus of advertisers, that patient care comes first. One shudders at the demand for productivity and profitability placed on VillageMD’ s remaining network of clinics, of which Summit Health clinics are now part.[1]
“Care at Every Connection” reads the tagline of Summit Health’s 2021 advertising campaign.[2]. “Absolute customer satisfaction” is engrained in the company’s business philosophy, and the ability to deliver such satisfaction “the driving force of our mission.”[3] Go to the summithealth.com website, where you are greeted with the sacrosanct message: “A Lifetime of Care.” In the hands of its advertisers and marketers, Summit Health has become less a healthcare corporation than a colossus of caring. Should you, dear Summit “customer,” have a problem, just reach out to the welcoming patient relations staff. The username of the email, in an unwitting nod to media theorist Marshall McLuhan, is the message: wecare@summithealth.com.
What have we here? Where was the caring ethos when I needed it? Where was my physician when I sought a connection? Why, after three brief phone calls, was I left disconnected and, more, threatened with expulsion from the office? No, the sloganeering insistence on patient care masks the corporate structure of uncaring, i.e., corporate, medicine. It is, I suggest, a classic example of what Alfred Adler, Freud’s errant disciple and founder of “Individual Psychology” (Individualpsychologie), termed “overcompensation.” Just as, for Adler, the drive to overcompensate inhered in inferior organs, so the overcompensatory caring dynamic inheres in the profit-driven commercialization of healthcare. This entails the transformation of patients, of vulnerable and often suffering human beings, into “clients” and “customers.”[4] With commercialization comes commodification, of patients as impersonal affiliates whose allegiance to one or another health plan falls to advertisers and their legions of slogan creators. The tiresome avowals of caring coalesce around a question, both conceptual and experiential, that requires further consideration: Where, in the corporate scheme of things, is caring located? And, more prescriptively, where can it be located?
I have now sent seven letters via email and the U.S. Postal Service to departments, offices, managers, and executives at Summit Health, and have yet to receive a single acknowledgment of receipt, much less a response to the issues I raise and the remedial actions I prescribe. Something is amiss, and it far transcends my personal experience. Many healthcare “consumers” have experienced far worse at the hands of healthcare entities whose commitment to patient care — now mutated into customer care — is broadcast from corporate rooftops and beamed down from the internet equivalent of Broadway signage. It is a matter, I suggest, of systemic factors that have not only deprioritized patient care, but threaten to drive a wedge between corporate healthcare and caring medicine.
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“Do you have a problem? Then please reach out to the caring patient relations staff of Summit Health. We want to hear from you. We’re here to serve you. Connect with us at wecare@summithealth.com.” Reflecting back on my experience with a Summit Health provider, a Summit Health office staff, and a Summit Health patient relations department, I am led to ask:
When does the caring begin?
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[1] American Hospital Association, “Walgreens shutters 150 VillageMD clinics after $6 billion loss” (https://www.aha.org/aha-center-health-innovation-market-scan/2024-04-09-walgreens-shutters-160-villagemd-clinics-after-6-billion-loss); Heather Landi, “Walgreens narrows profit outlook for 2024, takes $6B hit in Q2 from VillageMD investment,” Fierce Healthcare, March 28, 2024 (https://www.fiercehealthcare.com/retail/walgreens-takes-6b-hit-q2-villagemd-investment).
[2] “Summit Health Launches First Brand Advertising Campaign” (https://www.prnewswire.com/news-releases/summit-health-launches-first-brand-advertising-campaign-301364781.html).
[3] “Summit Healthcare Solutions – Business Philosophy” (https://www.summithcs.health/about-us/#:~:text=Summit%20Healthcare%20Solutions’%20business%20philosophy,compliance%2C%20dedication%2C%20and%20timeliness).
[4] On Adler’s concept of overcompensation, rooted in his theory of “organ inferiority,” see Paul E. Stepansky, In Freud’s Shadow: Adler in Context (Hillsdale, NJ: Analytic Press, 1983), pp. 49, 89, 114.
Copyright © 2025 by Paul E. Stepansky. All rights reserved. The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.
Medicine, Health, and History 