The Great Gaslight in Medicine

Opening: Charging What You're Worth 0:00

They want you to feel guilty about charging $300 an hour when a plumber charges $150 an hours. This ignores your 11 plus years of profit allows you serve more patients. If you can see five patients a day instead of 60, making two, three, four more times more, how much more time do you have to serve your community and people who can't afford health care? That's actually using your God given gift of being a healer for the best of mankind. You didn't build your clinic to feel like an employee in your own business.

I'm Matthew Kalogli and on Out of the System, hosted by Doctor Talks, we challenge the broken rules holding healthcare entrepreneurs back. Hear from clinic owners, rebels and builders who are creating bold, profitable patient center practices and doing it their way.

The Great Gaslight and Physician Worth 0:39

Welcome to another episode of Out of the System. And today, what we're going to do is we are going dive into this whole concept of being told that you're not worth it. Frankly, it might be the most insidious part of The Deception. In fact, its systematic destruction of your trust in your own worth. Like I always like to tell you and paint this picture with a story because I think it really paints it very clearly. And what I like to call this is I'd like this the great gaslight. And it's literally how an entire industry made you question your value.

So the first thing I think you have to do is you've got to understand what the hell is gas lighting. In 1938, British playwright Patrick Hamilton wrote Gaslight, the story of Bella Manningham being slowly driven to madness by her manipulative husband, Jack. Every evening, Bella notices the gas lights dimming and flickering. When she mentions this to Jack, he responds with concerned confusion. Darling, the lights look perfectly normal to me. Are you feeling all right? And day after day, Jack manipulates the gas supply while telling Bella's she's imagining things.

You're being hysterical again, my dear. Perhaps you need more rest. Your nerves have been so fragile lately. What Bella doesn't know is that Jack is deliberately creating these strange occurrences while positioning himself as the caring, concerned husband. His real cruelty isn't just the deception, it's making Bella question her sanity, her memory, and her basic ability to perceive reality. By the play's climax, Bella can no longer trust her own senses.

Gaslighting in Medicine and the System 2:06

She's become dependent on Jack's version of reality, even though his version is systematically destroying her. Now, imagine. You're Bella Manningham. But instead of manipulative husband, you have an entire medical system telling you that your perceptions about your own work were wrong. For 30 plus years, there has been a systemic attack on physician authority and expertise. You're being assaulted, and you're been gaslit, not just by one person, but by an entire industry. Take a look. Hospital administrators with MBA degrees telling you how to practice medicine.

Insurance companies positioning themselves as patient advocates against expensive doctors. Media portrayals showing doctors as greedy villains rather than highly trained professionals. Patient conditioning where Dr. Google makes everyone think they know better than you. Administrative gaslighting where you're told you just don't understand how this works, doctor. And it's no wonder burnout is at an all-time high. And it's no wonder doctors suicide rates are twice those of the rest of It is beneath a doctor to discuss money.

Actually, that's a lie. I was speaking to about 25 doctors at a conference when one raised his hand and said, but Matt, we were told that you should never discuss with a patient. And I got angry. Who told you that? Well, this older gentleman who was teaching us said a Doctor should NEVER discuss MONEY with his patients. Where did you take an oath that a Dr. should not discuss the money with their patients? In fact, studies show that patients WANT to talk about their care and the cost with the doctor and their doctor alone.

Why Doctors Should Discuss Money 3:48

Medical school programming has driven this into you. That discussing money is beneath you, the reality is that your patients want you to discuss money with them. They've told you that good doctors don't care about money, which is a deliberate manipulation to keep you financially dependent on the system. they've weaponized the Hippocratic oath against you twisting it from first do no harm into don' you dare charge what you're worth. Why is it that a lawyer can bill $800 an hour and everyone goes, ooh, he charges $80 an hours.

He must be really good. And that lawyer is considered successful. But a doctor charging $500 for a comprehensive consultation is consider greedy because there's psychological warfare being waged against you. Discussing money has become associated with being unprofessional and not focused on patient care. In fact, the reality is that patients want to know what's going on. They're getting bills for stuff that they never even knew existed and they don't know, what their care actually costs them. This whole concept of money being taboo needs to be thrown out the window for you to able to move out of the system.

Then there's the affordable care lie, how patients are being bankrupt while you struggle. I believe the Affordable Care Act is one of the worst pieces of legislation ever passed in this country, and you can quote me on it. Not because I don't believe we shouldn't provide health care to those who can't afford it, but because of what actually happened. The progressives were all excited. What they did is they said, let's make it so insurance companies can make more than 10% profit on their insurance premiums.

Yeah, that's a great idea. They naively thought that this would put a cap on the rates. But if you make $100 million in revenue and can only profit 10%, that's $10 million worth of profit.

The Affordable Care Lie and Patient Costs 5:21

If you generate $1 billion in revenues from healthcare premiums, your profit is now $ 100 million. So what did the CEOs focus on? Let's drive revenue, which means driving up healthcare costs. The US government said that in 2023, 60% of American families have what's considered a quality healthcare plan. Don't ask me what that means. that that family, the average American family will spend $16,500 out of pocket after health insurance premiums per year. I had an issue with my prostate five years ago and got an MRI.

With good healthcare coverage, my out-of-pocket was supposed to be $850. Three years later, I needed an M.R.I. in my back. Instead of running it through insurance, what if I pay cash? The nice person behind the counter said, it's $350. Same facility, same machine, less than half the price. The reality is patients spend hundreds of hours navigating the system for simple care. Let's say someone has a bad knee needing replacement surgery. There's going to be 18 to 24 months of procedures first. Every visit requires changing their schedule, taking time off from work, 30 minutes of driving to see you, checking in, waiting, getting called back, wait more, seven minutes with you then being told to come back in six weeks and then 30 minute driving back to work.

That's two hours in every single appointment out of the patient's life. By the time they get to have their joint replacement, they've literally spent 80 to 100 hours going back and forth and back-and-forth, not to mention all the out-of-pocket expenses for things that are covered. The reality is patients are pissed off, and they would gladly pay you money directly to spend enough time with them to really understand what's going on so they don't have to keep coming to see you. Then there's the guilt, and they try to make you feel bad for charging what you're worth.

There's an entire system designed to makes you guilty about charging your worth, this systemic conditioning begins in medical school and continues through residency.

Guilt, Training, and Serving More Patients 7:09

That money is dirty, that charging a lot means you don't really take an oath to help people. They've twisted the Hippocratic oath, the oath is really about doing no harm. When you look at the harm done by the insurance companies and the role they ask you to play in it, you are actually doing more harm to your patients by putting them through the Insurance system. The Hippocratic Oath has been twisted and manipulated to put you in a box. If you look at the history of the oath, it is designed to explore.

That's what science is. But they've used it against you so that you won't leave the plantation. They tell you, you took an oath to help people, but lawyers, accountants, and consultants help too. And they charge accordingly. They use your empathy and your desire to heal as weapons against your financial success. They want you to feel guilty about charging $300 an hour when a plumber charges $150. This ignores your 11 plus years of training. You have to realize that profit allows you serve more patients.

If you conceive five patients a day instead of 60, Making two, three, four more times more, how much more time do you have to serve your community and people who can't afford healthcare? That's actually using your God-given gift of being a healer for the best of mankind. Then there's the premium pricing paradox, why charging more increases patient commitment. There's a psychological principle. Investment equals commitment, the more a patient invested themselves getting better, The more likely they are to follow all the protocols to become healthy again.

This is one of the problems with insurance-based care. Patients have no skin in the game. They view it as free. People value what they pay for. When patients pay a $29 copay, they treat your time as worthless. when you charge $1,200 for them to visit you, They're going to be enraptured listening to you.

Premium Pricing and Patient Commitment 8:45

Medicine is not a discount. Patients don't want discounted healthcare. They recognize that if somebody isn't charging a lot of money, they automatically think the care is cheap and disposable. There's a universal psychological principle. Low price equals low value in the customer's mind. Think about the Walmart effect in healthcare, most people think that to be successful, They have to see so many patients as possible like Walmart, but you can't provide some healthcare by being Walmart. Let me give you this analogy.

Let's say you need to hire a lawyer for a major legal issue. If this isn't solved, you can go to jail. You talk to the first lawyer, it's $200 an hour. The second lawyer $800 an hours. And which one are you going to higher? When I asked this question in groups of doctors, 99% of the people say they're going hire the $800 an-hour lawyer. They don't ask about the lawyer's credentials or where they went to school or their experience. they automatically think the lawyers who charges more is better. That's the same way patients think about your Then there's cultural gaslight, how the system makes you question your value.

There's been a systemic attack on physicians' authority and expertise over the last 30 years. Media portrayals show doctors as greedy villains rather than highly trained professionals. Patient conditioning creates factors-don't-know-anything-just-google-it mentality. Insurance companies position themselves as patient advocates against expensive doctors. Well, of course, they're all driving brand new BMWs. And then there is administrative gas lighting. Hospital administrators with MBA degrees telling you not to practice medicine.

Every protocol that contradicts your instincts damages your authority with patience. Every insurance denial of your clinical judgment erodes your competence. The system has created an entire environment where you question your value when you should be competent in your expertise. You've spent more time training than almost any other profession, yet you've been conditioned to apologize for charging appropriately. The do good equals stay broke fallacy and why sacrifice has positioned as noble. There's religious and cultural programming that equates poverty with virtue and helping profession.

Cultural Gaslighting and the Value of Doctors 10:39

The system exploits your altruistic nature to justify underpaying you. the martyr complex says financial struggle makes you noble Bullshit. Financial struggle doesn't make you a better doctor. It makes you worse one. When you look at the harm done by financial stress, sleep deprivation, burnout, resentment, you're actually providing worse care. Wealthy doctors can do more good, not less. Look at what doctors who built wealth have done. Free clinics. medical missions, research funding, the opportunity cost of staying broke is what you can't do for patients, families, and community when financially constrained.

The scarcity trap creates a vicious cycle. Financial stress makes you a worse doctor, which makes feel guilty, makes charge less, creates more financial stress. Systemic benefit of keeping doctors poor is that broke doctors don't have power to change the system. So, then there's the pricing psychology truth in what patients actually think about low prices. There's a universal psychological principle. Low price equals low value in consumers' minds. Patient testimonials consistently show, I was worried about the chief doctor.

What's wrong with him? Investment psychology shows that patients who pay more are more engaged, compliant and successful. There is a direct relationship between the patients, what patients pay and how they treat you. Premium patients become your best ambassadors and refer patient premium patients. In contrast, discount patients refer bargain hunters. Market positioning psychology means premium pricing positions you as the expert, not just another option. Higher prices signal confidence in your abilities to your pages.

Why Wealth Lets Doctors Do More Good 12:06

When you discount your services, you're sending the message, I'm not worth the full price. Nobody wants discounted healthcare. when they're sick and want to get better, they want be taken care of. They want their problem to go away. And price tells them everything about how you bound your skill set. I hope you enjoyed this brief little episode of Out of the System, and we'll be talking to you again next week.