The McDonaldization in Health Care

According to George Ritzer, bureaucracy completely dehumanized the social institutions in America. He sees the bureaucracy as having four components: efficiency, predictability, control and quantification. He terms this dehumanization of an institution as "McDonaldization". One of the most prevalent examples in modern society is the health care institution. In the past, health care was more simplistic in nature. House calls were not unheard of, and doctors knew all of their patients and their families on a personal level. The doctor who delivered your parents would deliver you as well as your future children. Follow-ups were quite normal; doctors were concerned with your progress for their own peace of mind. It is only recently that the health care system has emerged as the McDonalized bureaucratic organization that it is today. All the characteristics of bureaucracy that Ritzer mentions in his book are plain to see when one looks into the modern health care system. From something simple like a trip to your doctor for check-up to an urgent trip to the emergency room; it's not hard to find predictability, control, efficiency, and quantification engrained in every aspect of health care. McDonaldization is irrevocably changing healthcare.

Quantification is easily observed when you arrive in a hospital waiting room and a big sign gives you a number before you are able to make any type of human contact. After waiting for a good bit of time your number is finally called, and before you are able to anything else, you must first present the receptionist with your insurance card. Only after doing this can you be given your file number, which during the time you spend within the hospital is your only identity. After you see the doctor, you come out with a prescription or two, a process that only serves to further your nameless, dehumanized ordeal. When you go into a pharmacy to have a prescription filled the first thing the pharmacist asks you is if you know the prescription number of the medicine you want filled. You are a prescription number, not a person. If you don't remember it, only then is your name used as secondary possibility for means of identification of you medicine. Before you pay you have to show your other insurance card, which is once again reducing you to a series of numbers. Thanks to the McDonaldization of the healthcare system, the whole doctor vist/perescription filling experience is a very impersonal one.

Efficiency is another bureaucratic characteristic that is prominent in the hospital visit aspect of the healthcare system. When you need to go to the hospital you must call ahead and make an appointment with the receptionist. This avoids the long lines of people waiting to see the doctor which are commonplace in our health care system. Each person reduced to a number series, just like you. Making an appointment before hand makes the doctor visiting process an efficient and expedient one, but one made necessary by the McDonaldization of health care. It arises again with the doctors themselves. When a doctor is on duty and makes rounds, he goes from exam room to exam room, where each one has a patient already waiting inside. After he assesses the need of a patient, the doctor then visits another one while a nurse brings in another patient into the empty room. This way the hospital can get people in, out, and on their way as quickly and easily as possible, and at the same time, servicing the most amount of people in a day they can. This sounds more like an industrial machine then true health care. Thanks to McDonaldization, the heath care system is more mechanical then ever.

Hospitals, like machines, pride themselves on being as time efficient as can be. Simple illnesses like flu can be diagnosed quickly with no need to see the busy doctor by having the nurses make a preliminary examination first. This allows the doctor to only have to get involved if the person actually has something they deem worth their time.

We return to the pharmacy for another aspect of heath care where efficiency is made paramount. By calling the pharmacy ahead of time to have a prescription filled, once again long lines can be avoided. Some pharmacies can have prescriptions delivered to your home, much like a machine would.

Predictability is a big characteristic in the McDonalized healthcare system. A simple visit to the doctor now has become formulaic. First the receptionist fills out the necessary paperwork and informs the doctor you have arrived. Then you wait until a nurse comes into the waiting room and informs you that doctor will see you now. Most times this is not actually the case, in actuality it means that the nurse will now take your temperature, pulse rate, and blood pressure.

Like a perfect automaton, the nurse proceeds to measure vital signs and note her findings with as little human interaction with you as is possible. After the nurse has completed her tasks, you must wait until the doctor pops his head in, nurse's records in hand. The doctor then proceeds to ask you some variation of the stock doctor question: "What seems to be the problem today?"

You then inform the doctor of all your symptoms, which he processes and eventual comes up with a diagnosis, much like a computer would. The doctor then either gives you a prescription or advises you to "stay in bed and drink lots of fluids", another stock doctor phrase. If it is necessary according to the diagnosis made, the doctor may decide further tests to be necessary.

If further treatment is required, you basically must go through the exact same routine you just went through, only this time on another day and with different people. If prescriptions are required, you go to the pharmacy, get the prescription filled, and get the privilege of listening to the same warnings about finishing all of the prescriptions, side-affects, the dangers of interacting drugs and alcohol that you have heard many times before, all stickered on the side of the prescription bottle. The heath care system has become predictable, but at the cost of a feeling of individual care.

The fourth component of McDonaldization, that of control, is one of the most important to the health care system. The doctors and nurses that make up the health care system have absolute control over our health and our physical well being. Although doctors don't have the kind of power and responsibility that they possessed a century ago, their influence is still quite vast. Just by having you to sit in a waiting room and wait for another person, in this case the doctor