Some truths are revealed about the state of American medicine in this survey:
And one physician says his hospital’s young chief operating officer once compared the hospital to a donut shop. The COO told the physician: “We are like a donut shop. Our job is to sell donuts. If we don’t sell a lot of donuts we go out of business. Your job, as chief of emergency services, is to convince patients they need to be in the hospital and to convince doctors they have to admit patients. It is not your job to decide if the admission is good for patients.”
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{ 4 comments }
Physicians must always remember that their duty is to their patients, not the chief operating officers, not the lawyers, and not their own pocketbooks. If physicians could return to this original duty, and if patients could then see how the physician is their most trusted advocate in the health care system, then some of these outside influences might lose their ability to affect the physician-patient relationship.
I agree and will take it further. Most doctors do remember that is their first duty. Too many put themsleves first–that has always been true of a small minority. Unfortunately too many would be doing their duty to their patients but let themselves be coopted by others, out of insecurity, allegience to authority, fear of being labeled a troublemaker, etc.
Defense of the doctor-patient relationship requires constant vigilance and a readiness to say “No!” and tolerate criticism and hold firm against manipulation. In some cases, it ultimately require that one vote with their feet.
That mean that being an ethical physican in this age requires that one keep one’s finances flexible enough to permit resignation at any time if needed–a smaller mortgage, older car, cheaper schools. Failure to do so will result in rationalization of compromises which, unless you are good at rationalization, will lead to a grinding soul-killing guilt and eventual demoralization.
Unless you are a sociopath at heart, in which case this is your golden age baby!
One GOOD thing that declining reimbursements and a bigger medicaid/uninsured population has given doctors: the wherewithall to say f!@& you to hospitals and their CEOs.
Now it makes sense to consider not maintaining hospital admitting privileges at all. That way, no on-call responsibilities, indentured servitude (ie. medicaid/uninsured), and no CEO/COO telling you how to manage patients.
Thank god for the hospitalist movement.
The few hospital administrators I have had the misfortune of meeting were borderline psycopaths. Their priorities were clearly money/hospital first, patient second. (doctor and staff far third). Do not ever trust anyone who works in an administrative capacity in a hospital, their goals are in direct opposition to yours.
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