How do you know if you’re a disruptive physician?

Physicians are being attacked in many ways and in many places.  It is no longer about how able, available, and affable you are.  It is about how well you toe the line when it comes to going along to get along while being watched by an ever increasing line up of watchdogs.  Many of whom have sharp teeth.

Here are a few questions that might indicate you are headed for trouble:

Do you speak your mind when you are concerned about quality of care?
Do you give directions in an authoritative way?
Do you command a large practice which is the envy of others with whom you compete?
Do you ever question the hospital administration about procedures or policies?
Do you ever use seemingly appropriate humor to defuse a situation that is tense?
Do you ever go against the tide of opinion about the clinical care of patients?

Well, if you answered “yes” to any of these questions, and I surely hope that you did, then you might very well be regarded as a “disruptive” physician and headed for some real trouble.  Physicians’ relationships with each other, with hospitals, and with regulatory agencies are becoming ever more complex, and ever more dangerous for physicians.  Physicians are increasingly being targeted when they get in the way.  Loss of your practice, your hospital privileges and even your medical license can result.  While this can happen to both men and women physicians, women physicians face additional challenges.

So what does this mean for women physicians?

Women physicians are increasing in numbers, but the workplace has not yet adapted to their different attitudes and work habits and work styles.  Thus, much of what they do can be misinterpreted and they can become easy targets for disciplinary action.  Let’s take each of these “situations” and see where the danger lays.

Communication.  When you speak your mind, be careful in the use of language, voice, and context.  Assertive women are out of character (i.e. they don’t demonstrate gender stereotypical “good girl” behavior) and are vilified more easily.  This also goes for how you give direction (i.e. orders) to staff members. Learn to modulate tone and language otherwise you might be “written up.”

Competition.  Being competitive was one of the reasons you made it all the way through the difficult road to becoming a doctor.  Most of us want to be successful.  But when you are, be careful to respect your competition. They can and will get very jealous.  And they will try to bring you down, usually citing bogus quality issues.  There are many who still think that women don’t need to work because others are there to care for them.

Corporatization.  Wondering why a quality issue is not being investigated?  Are you puzzled because some policy is being changed without appropriate physician input?  Questioning a hospital administration today can be regarded as an act of insubordination, especially if you a hospital employee.  And the “administrative physicians” are aligned with the corporation which in most cases is not aligned with your interests or the interests of your patients the same way you are.  Be very careful and make sure you understand the politics and who is really “in charge.”

Collegiality. One of the greatest tragedies in today’s medical workplace is the loss of collegiality.   Appropriate humor helps to diffuse tension and to build camaraderie.  Recognizing that some humor was sometimes hurtful to women physicians, no humor is equally, if not more, harmful.  Humor bridges gaps and can lets everyone in.  Try to find ways to be collegial and professional by keeping good humor in the workplace.

Change agent.  Some women are entrepreneurial.  Some think out of the box.  Some have different points of view.  These women are agents of change.  In this day and age of protocols and guidelines, make sure you are familiar with “the standard of care” in your community before you start changing the game too radically.  This is especially true for the young and inexperienced.

These words of warning are to help you stay out of trouble and avoid becoming a target of an investigation for being a disruptive physician. Some environments welcome physicians who speak up, are clearly directive, who are sought after, question the status quo, have a sense of humor and innovate.  And then, sadly, there are far too many places that are not.   Look not only for the policies and procedures where you are on medical staff but also read the medical staff by-laws.  These are important documents for you to have mastered, otherwise you might find yourself targeted as a disruptive physician.

Linda Brodsky is a pediatric surgeon who blogs at The Brodsky Blog.  She is founder of Women MD Resources.

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  • http://www.facebook.com/people/Roy-M-Poses/757544028 Roy M Poses

    You provided another argument why doctors should not want to be corporate physicians, and why patients should not want to be treated by corporate physicians. See: http://hcrenewal.blogspot.com/search/label/corporate%20physician

    • LBENT

      I agree, but if you are a surgeon you have to maintain medical staff privileges so it is impossible not to come into contact with corrupt administrators (many of them physicians) and corrosive policies. Linda Brodsky

    • PcpMD

      You cite a very important paradox. The vast majority of patients WANT a corporate middle-man to come between them and their doctor, at least at the register (when its time to pay for the care). They just don’t want ‘em on the other end (the exam room). I’m not sure you can have both. “He who controls the purse strings makes the rules”, as they say.

  • http://www.facebook.com/people/Samir-Qamar/1843287708 Samir Qamar

    Good warnings. However, it should be pointed out that change does not happen without disruption. Direct Primary Care has disrupted the healthcare system by removing the need for health insurance in primary care by daring to make it affordable. Only physicians, innovative and challenging in nature, will be the ones making the changes by becoming disruptive. Some of us will end up with arrows in our backs, but those courageous few will hopefully inspire others to also be positively disruptive. The key is to be disruptive, not destructive.

    • LBENT

      Dear Samir,

      As a crusader my whole life for quality medicine and equal rights, I couldn’t agree with you more. However, if you are disrupting the plans of people who have another agenda, and you don’t have the power, being disruptive will only be destructive to you. And then where will you be? It is very much a McCarthy era in medicine right now for physicians who dare to speak out in places where quality care is secondary to outward appearances and other equally odious agendas. Linda Brodsky

      • ninguem

        One important fix that is available in a few states, and we should have everywhere. Noncompetes in medical employment contracts should be declared null and void.

        If you really are “disruptive” because you’re mentally disturbed or substance-abusing, no one else is going to want you.

        If you are tagged as “disruptive” because you advocate for patients against a toxic administration, it is quite possible a more hospitable place is available nearby, and the market will sort this out.

        Noncompetes are not allowed among lawyers, because the Bar says it interferes with the public’s ability to access lawyers. It is reprehensible that we physicians do not conduct our business affairs with the basic ethics that even lawyers follow.

  • ninguem

    And then, all you need is a corrupt hospital administrator (read: all of them), and two paid-off doctors, and any physician can be tagged as disruptive.

    • LBENT

      exactly–Linda Brodsky

    • http://www.thehappymd.com/ Dike Drummond MD

      Really … ALL hospital administrators are corrupt and they pay off doctors to accuse their colleagues. WOW … Really? If this is what the public, the administrators in healthcare, the politicians and our patients hear when they see doctors commenting on the web … no wonder we are often seen as part of the problem.

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

  • http://womanfoodshinyobjects.wordpress.com/ Brian Stephens MD

    A pure doctor patient relationship allows the doctor to advocate for the patient and ask all of these GREAT questions.

    But, the only “pure” doctor patient relationship is one where the doctor works for the patient.
    you cant be paid by anyone else and expect to have a pure relationship with the patient.

    • LBENT

      It’s very hard to do–doctors rely on many different organizations to get paid for treating patients, especially if the patients are children who rely on others to provide for their health needs.–Thanks for responding. Linda Brodsky

    • http://www.thehappymd.com/ Dike Drummond MD

      Thus the popularity of concierge and direct care practice models. It always works better if your patient is the one writing the check. When patient = customer … things get so much simpler.

      Dike
      DIke Drummond MD
      http://www.thehappymd.com

    • http://www.facebook.com/davidwongmd David Wong

      Agreed – we’re trying to restore the pure doctor-patient relationship — old fashioned – patient simply paid the doctor… directly… for his or her care. No third-party payors, no hassle.

  • Bradley Evans

    Thank you for this article. Thank you Samir for your comments. Thank you, thank you. Although I am in private practice, I have been on trial twice by hospital administration and physicians for 3 different issues, as a disruptive physician. I am still hanging in there. Good luck to others in this situation. Good luck to women in this situation. The best advice is from Dr. Linda Brodsky.

  • Demax Medical

    Thanks for your aticle, very usefull..

  • DavidBehar

    Disruptive physician is feminist lawyer code for male doctor. The target of such a witch hunt should be merciless in seeking the personal destruction of the feminist enemy of clinical care and its male running dogs. Always, initiate ruinous litigation against the person and the institution. Even if the action is dismissed on first pleading, the adversary will lose its job. To deter.

    If one has patients prone to violence, inform them of the hindrance to their care from the unfair, bad faith actions of the feminist and its male running dogs. If they want to visit such enemies in their places of business and bust up the places, who is one to interfere?

  • Jenness

    I find it laughable that so many of you blame “corporate” medicine when CMS/Medicare has literally forced all the Private Companies to adopt to their coding, their reimbursement sets for years now that has broken the financial back of doctors and hospitals.

    Keep in mind that gender-wise we have yet to have a female president, our secretary of state is currently being thrown repeatedly under the bus so the President won’t have to answer for Benghazi or Fast & Furious but corporations have been led by women for years quite successfully.

    Perhaps if the fight is placed more squarely on the legislators the climate could change back to a more free enterprise state where everyone regardless of race, gender or background has the chance for their voice to be heard based upon individual merit and soundness of idea – rather than mindless ranking systems based on who can put up with the most crap for the longest amount of time and not make waves at all.

  • http://www.thehappymd.com/ Dike Drummond MD

    Linda … you make it sound like “disruptive” doctor is just a successful physician who speaks their mind and stands up to the “Bean Counters”. As if the label is always inappropriate.

    What about this very common scenario. The doctor who is rude, abrupt, shouts and throws things – sharp things – with little or no warning. The doctor who the nurses won’t work with so the managers have to “schedule around them”. The one who their own physician partners say … “He is a great doc AND he has to change or we are going to have to kick him out of the practice”. Everyone knows a doctor like that in your own community or group.

    That is the appropriate use of the word disruptive and this person is issuing a cry for help. It is tough to hear/see with all the acting out AND in my experience they are suffering from severe burnout, and are unaware of the way they effect the people around them. They are usually good clinicians and no one doubts their skill or clinical judgment – think “House”. They are almost always men. They are typically miserable, holding on by their fingernails, feel like they are being persecuted or surrounded by idiots and don’t see the pink slip coming.

    A direct and compassionate intervention can identify and address the burnout, equip them with the ability to see how their actions cause the upset around them and return them to their rightful place as a contributing and valued member of the hospital staff or group.

    The tragedy is if this person is simply fired or let go or just chronically demonized and marginalized. Here a detailed description of this doctor and a program that is successful in preventing their dismissal 80% of the time.
    http://www.thehappymd.com/services/disruptive-physician-intervene-evaluate-educate-rehabilitate/

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • http://twitter.com/cocococo10 Coco Lossil

    Linda – still trying to work out how the workplace you have described here is any different to the non-medical workplaces I worked in for 40 + years. Universities are far worse and the salary not as good! Everything you have described here sounds like most workplaces.
    My question is – what led you to assume that being an academically gifted medical graduate with a lively personality somehow exempted you from the same workplace garbage everyone else experiences?
    There is no get out of jail free card on these things. Let me fast forward over 40 years of experience into the inevitable conclusion – this always comes down to leaving [assuming you can actually find a work location more congenial] or staying and knuckling under or becoming one of the reviled medical administrators in the hope you will do it better [not always the case, sadly]. All the agonising in between is just a waste of valuable time, changes nothing or just makes it worse.

    • http://www.facebook.com/people/Michael-Rack/100001703895437 Michael Rack

      Two differences:
      1. A doctor has obligations to his/her patients, even if he is an employee. A barrista at starbucks or a car salesman does not have the same obligations to customers.
      2. An employer can take action against a doctor employee’s medical license.

      I do agree with you that doctors spend too much time whining and agonizing.

      • ninguem

        Let me add to that.

        The coffee shop doesn’t force you into a restrictive covenant preventing you from working the stand down the street……or opening your own for that matter.

        The state doesn’t arbitrarily determine how many coffee shops may exist in a given area, again preventing you from opening your own coffee shop.

    • azmd

      Here’s a difference: in most workplaces, people don’t die if you make a mistake. The very nature of medical work is much more stressful than the work that is done in the corporate world and in academia. Also, I doubt very much that workers in either of those settings are expected to routinely stay up all night taking care of people as part of their job. As such, I think it’s reasonable to assume that it’s more important for doctors to not find themselves being distracted by petty workplace harassment.

    • LBENT

      I only have 35 years experience. I have been in several systems. Some are toxic and some are not. And those of us who have given a tremendous amount of ourselves to our profession, and it is recognized by our peers, when we speak up, we should hopefully be heard, not beaten down. If it is not so for us than how much worse is it for the quieter guy.

      Medical care and how it is given should be held to a higher standard and is not “business” alone.

      I don’t agree that telling the stories makes it worse. Shining a light on injustice and stupidity is the only way to make change. Linda

  • Doug Capra

    Good article, but it leaves out one essential element within the hospital culture — the patient. All the topics mentioned above can apply to provider relationships with patients as well. You can’t, cannot, leave the patient out of any scenario within the hospital, except perhaps when the patient is out cold in the ER or OR, and then you may have had to deal with the patient beforehand, or with relatives. I would suggest there may be times when the physician or other caregiver may not be “disruptive” at all within the medical professional culture of the institution, but may be disruptive in relationships with patients and their relatives. And in a culture where many patients don’t feel comfortable enough to speak up, the provider may not even know he/she’s being disruptive or harmful or appearing to be insulting or uncaring.

  • Charlotte

    I would say this article is offensive, but I’m a woman and I don’t want to be seen as “disruptive.”

    • LBENT

      I would like to know why this article is offensive? These issues are important to discuss. Could you elaborate? Linda Brodsky

  • cjnyc

    I am a former chief of my department who was terminated by the hospital CEO in a meeting with the COO an hour after I tore up and threw my annual performance evaluation in the face of the CMO when she refused to explain the basis of the evaluation. I behaved that way because I hated my job, in which endless admininstrative emails and politics was eating away more and more of my life ( 36 hours a day, 8 days a week) and the CEO refused to hire additional MDs based on advice of the CMO, who told him what he wanted to hear. I sued that my performance evaluation was in retaliation for my bringing up issues about ACGME inadequate resident supervision violations ( the CEO and CMO wanted me to lie to ACGME that my specialty residents were being supervised daily on an inpatient rotation, even though my department attendings were all hired as consultants assigned to see patients 2x/month, and the overworked doctors on the daily inpatient service refused to round and teach the specialty residents I was hired to supervise ), as well as DOH and JCAHO violations. They gave me a 6 figure settlement within 2 weeks of being fired, changed my termination to a resignation, and gave me a very nice LOR from the CEO that I helped write. One month after I was fired, they fired the chief nursing officer; ACGME cited them and one of NY’s best hospitals in the country for violations in colluding with the admistration of my specialty hospital; the next month the chief of the inpatient service resigned; and then the CEO and trustees decided to demote the CMO who got me fired after the CMO had run out of scapegoats to blame. All this happened within 6 months of my getting fired. The number of non medical administrators in the mahogany C-suite of the hospital continues to grow. They listened to my white male lawyers, but had refused to listen to me or let me do my job to protect patients and students because I was a non white female.

  • http://www.thehappymd.com/ Dike Drummond MD

    Hey ninguem … take a breath dude … not saying it never happens. My point is that this is not the only situation where the word “Disruptive” comes into play in healthcare.

    I work with physician groups, where physician members of the board of that group are trying to decide what to do with a physician colleague because that person is so disruptive that they have to change — or this group of their partners, peers and fellow physicians must fire them by decree. THAT happens too … very frequently AND the term they will apply to the doctor is “Disruptive”. Two flavors here and I acknowledge both of them.

    And if you are the doctor in this situation who is seen as disruptive enough to fire by your peers … you will not see it coming because of your burnout. I am the person you want to work with … not a bean counter, not a lawyer, not trying to fire you or get you out … giving you a last chance to stay IN because your Peers want that for you.

    Make sense?

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • ninguem

      I’m not your “dude”.

      I’ve just presented you with facts. Lots of them. Newspaper series and law review articles. If there’s anyone ignoring things it’s you. Your response is “take a breath”, as though presenting facts somehow makes a person unhinged.

      This thread is not about the psychiatrically disturbed physicians it’s about perfectly good docs who have advocated for patients and for individual physician rights against a less-than-ethical administration. It’s about doctors who have the temerity to be successful against politically-connected and hospital-employed docs. They get tagged with the word “disruptive” and get lumped in with the docs showing up drunk or abusing nurses or throwing things. The weight of the entire administration and the medical board comes down on physicians so targeted and it is extremely difficult for that doc to put his/her life back together.

      Those cases happen and I’ve seen them. Fortunately not to me personally, but I follow Martin Niemöller’s warning and speak out.

      This is not about doctors with substance abuse disorders or psychiatric disorders. Plenty of threads on that subject where you can flog your business.

      • http://www.thehappymd.com/ Dike Drummond MD

        Not a dude and not taking a breath … got it. BTW, I don’t work with doctors who are mentally ill or have a substance abuse disorder. and not “flogging” anything. I do have a question though and sincerely want to know your answer.

        What is your solution to all this mess?

        You have clearly outlined what you see as the problem. What is the solution? Neither you or Dr. Brodsky have outlined what you would like to see happen differently and I really want to know..

        Your thoughts?

        Dike
        Dike Drummond MD
        http://www.thehappymd.com

        • ninguem

          Somehow I don’t get the feeling you want to know at all.

          My first suggestion is maybe you might want to recognize that sometimes the peer review process can be abused.

          • http://www.thehappymd.com/ Dike Drummond MD

            ninguem … I agree with you. Corruption can exist in any organization and even peer review inside healthcare … I agree already. You are the one who has felt I was disagreeing with you and completely failed to see that I was showing you the double meaning of “disruptive”. There is one meaning when an administrator uses it and another when your peers and physician practice partners use it.

            The peer review process is corrupt … OK … then what. Do we just give up? Do we roll over and play dead? To we publish comments on KevinMD.com and stop there? What comes next?

            If I listen to you and Dr. Brodsky … between the lines is what sounds like a warning not to participate in any input into the system in which your care is delivered because it is not fair, you will get labeled … something like that.

            So if you have a suggestion for how to function as a quality doctor in this situation I would love to hear it. So far you have dodged the question twice and what it sounds like we all really need is some thoughts on a solution. Got any?

            Dike
            Dike Drummond MD
            http://www.thehappymd.com

          • ninguem

            First of all what you mean “we” kemo sabe, you don’t practice medicine anymore.

            Second, no need to pat yourself on the back how clever you are, I did not “completely fail” to see anything.

            There are docs who deserve to be thrown off, heck they deserve license revocation. They are “disruptive” in the classic sense of the term. Others were railroaded by the system because of competition or better practice.

            And you know, or should know, that that sort of behavior goes back to Ignaz Semmelweis in Austria, and probably before.

            You know, or should know, about the Patrick case in Oregon. It was presented back in the early 1980′s as a bad doctor using the legal system to get back at honest doctors trying to protect the public.The facts behind the case are otherwise…….actually downright egregious, Patrick was treated horribly, and the malfeasance of the administrative doctors went all the way to the Medical Board.

            Everything I’ve just said is on the public record, look it up yourself.

            The result of the Patrick case was HCQIA, and what it did was protect the very bad behavior that was done to Patrick. Now the next doctor treated like Patrick would not be able to sue.

            Some reforms of HCQIA are suggested in law journal article, I cited one, I assume you read it.

            Second, noncompetes in medical employment contracts should be null and void by law, and unethical by the medical organizations. Same as what the lawyers do among themselves. If Dr. Smith doesn’t get along with County General, let him go down the street to Mercy Hospital, if they will have them.

            If Dr. Smith isn’t getting along with County General because of bad behaviors, he won’t last long at Mercy, and likely they won’t even want Dr. Smith. If the problem between Dr. Smith and County General was, in fact, County General, the doctors and the public will vote with their feet.

            Of course, those here with an administrative background will likely not want to lose the ability to take the ball and go home. Voiding noncompetes as a condition of Federal funds, was in a Stark-type provision a few years ago, nice how the hospitals managed to get that removed.

            Lawyers do it, every Bar association in the country prohibits noncompetes, no reason why doctors can’t do the same.

            Pass-throughs allow the hospitals to get twice as much pay for the same service as a private doctor. The effect of this on healthcare cost is starting to get the attention of policymakers. When they can no longer extract twice the pay for the same service, perhaps hospitals may have less motivation to take over every physician practice and use any means, fair or foul, to drive the private doctors out of town.

          • http://www.thehappymd.com/ Dike Drummond MD

            By “we” I mean the two of us commenting here on KevinMD.com. If you want to play the Lone Ranger though … that is OK by me.

            Thanks so much for putting some solutions out here for us all to see. You are obviously knowledgeable on this subject … and your opinion is important … it is a tragedy it is like pulling teeth to get these suggestions out of you. Good golly.

            So what I hear you recommending is

            1) HCQIA reforms so that peer review immunity can’t be abused as it has been in the cases you cite

            2) Outlaw non-competes in medical employment contracts so docs can pick up and move along if they wish

            3) Eliminate pass throughs that allow hospitals to make more than private docs for the same procedure to take the financial pressure off them to steal the outlying independent practices.

            Anything else … or would that make a meaningful enough change that we should be lobbying for that slate of reforms as a unified profession?

            Dike
            Dike Drummond MD
            http://www.thehappymd.com

          • LBENT

            The hospitals are at war with doctors. Being “disruptive” is being used in ways that are corrupt. Truly “disruptive” doctors are easy to spot. But the term has taken on new shades of meaning and depending if you are favored or not, you may find yourself in a lot of trouble. I get calls almost weekly from people who are in such trouble. Linda Brodsky

  • buzzkillersmith

    If you work for a corporation, you are owned by a corporation. Those that lie down with dogs should not complain of fleas.

    Corporate medicine is a tough world for outpatient primary care. And make no mistake about it: independent or group practice, when paid mainly by insurance companies, is corporate medicine. The government is no better, as you all know.

    What is a medical student to do? Perhaps the best option is not to go into primary care, at least at this time. Turn it over to those midlevels that will have it. This is the strategy that most medical students, no fools, are following. The problem is that society will find this situation suboptimal. Expect patient (citizen) complaints about gross incompetence. Expect more consults, more hospitalizations, as midlevels are no longer able to skim the cream of easy cases. Expect the society to find out, who would have thought it?, that having physicians manage outpatients, or at least supervise the management of outpatients, is a good idea. This might take a few years or a decade to sink in. And as Dr. Drummond has so eloquently pointed out at this blog, managing a large clinic full of midlevels, MAs, perhaps even lay workers, in a sisyphean attempt to help sick people gives little joy. Those doctors will have to be paid very well indeed. There will still be a big shortage.

    The other option is direct primary care. This works for the doctors and patients involved but leaves the mass the patients in the hands of half-trained persons.

    America, through its elected and appointed representatives, is speaking loudly and clearly to today’s medical students. It is sad to see how this will go and not to be able to do anything about it.

  • http://www.thehappymd.com/ Dike Drummond MD

    So what is the solution here Dr. Brodsky and @ ninguem ? I get what you think is wrong. What is the way forward in your opinion?

    What is the way that you can get your power back in a world (as you describe it) where ALL hospital administrators are “corrupt”, ALL doctors can be bought and every successful doctor who is forthright with their opinions is labeled disruptive and marginalized.

    What are your suggestions for a solution .. or at least the start of one?

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • ninguem

      First suggestion is you can do is stop putting words in my mouth.

      • http://www.thehappymd.com/ Dike Drummond MD

        Nice dodge and the ball is still in your court …

        What is your suggestion for a solution? Where do we start?

        Dike
        Dike Drummond MD
        http://www.thehappymd.com

        • LBENT

          We start by getting rid of these ridiculous, probably illegal, witch hunts that are under the guise of “fair hearing” whenever a physician is considered “disruptive”. If there is really a problem, an outside review with people who are trained in cultural differences, will have nothing to gain or lose, and who are not in the pay of the hospital, would be considered. Physician targeting is real. It happens to good doctors unfairly, it destroys careers, and it is an abuse of power. Takes a lot of time away from our real work. If some “rolling their eyes” is considered disruptive, or someone raising their voice at a code, or reporting a serious breach in quality control to the department of health, are disruptive, then there is something very wrong. Physician administrators have to be held to the same standard of behavior and stop threatening and trying to hide bad care for which they are responsible. Is that enough of a start?
          Linda

          • http://www.thehappymd.com/ Dike Drummond MD

            And how do you suggest we get rid of the witch/warlock hunts and physician targeting and hold administrators to a higher standard?

            - Does the medical staff create an oversight committee?

            - Do we need a government body to come in and do something?

            - Is it time for a national physician’s union with collective bargaining rights?

            - Or do you back down when labeled as “disruptive” and decide whether or not you want to continue to work at this facility?

            Or what … what do you suggest for the HOW here?

            @ninguem has suggested the following three actions — do you agree and what would you add to this list?

            1) HCQIA reforms so that peer review immunity can’t be abused as it has been in the cases you cite

            2) Outlaw non-competes in medical employment contracts so docs can pick up and move along if they wish

            3) Eliminate pass throughs that allow hospitals to make more than private docs for the same procedure to take the financial pressure off them to steal the outlying independent practices.

            Let’s come up with some proposals for solutions here … otherwise this is just venting.

            Dike
            Dike Drummond MD
            http://www.thehappymd.com

  • Suzi Q 38

    I am a patient.
    I had a nerve problem with my legs after a hysterectomy.
    the neurologist and the gyn/oncologist were roommates at their undergrad college. I didn’t know it, but they took their time with getting me help.
    Finally, I developed more symptoms and went to a gastroenterologist who was very brave and asked me to tell my doctors that the problem was with my upper spine, not just my lower one.
    This forced a discussion, and I demanded a full MRI (I had PPO insurance) and got one. Bingo. Spinal stenosis.

    Too bad it took about 1 1/2 years and a ruined 30TH anniversary trip complete with escalating pain and symptoms, difficulty walking to make them see that I had not been the hypochondriac that they thought I was for the last year.

    My point is, why do doctors risk their reputation by covering for each other?
    My heros are the gastroenterologist provided a direction for the neuro to follow, and a neurosurgeon that personally called my GYN/oncologist to admonish him for not answering my letter of concern about my symptoms and problems before I left for vacation.
    Allowing my condition to worsen during my vacation without instruction may have left this condition permanent.

    Thank goodness I am improving.
    I have forgiven those two doctors (the neuro and the gyn/surgeon), but I sudder to think how long this would have gone on without the other two doctors (gastro and neurosurgeon) fighting for my care and the correct diagnosis.

    Prior to this blow up, the neuro just prescribed me neurontin and told me to live with the myelopathies. Good thing I refused the drug until it was discovered what the problem truly was.

    I told the neuro: “Why should I take this for the numbness that has developed and escalated in the last few months? If I do that you will not truly know what is wrong with me for months or years.”

    I hate when I have to suggest ideas to a doctor.
    I have no medical experience, just my symptoms.
    I had to research various similar conditions on the physician publication “Up To Date.” I hated asking the doctor if this or that could be at the root of my myelopathies. It just seemed like they did not care.

    UGH.

  • Steven M Hall, MD

    I am in primary care and I’ve been in and out of insurance networks. I’ve weathered two insurance audits because I do one-hour visits with my patients and work in multi-systems detail with people who have seen all the specialists and have been written off by the system. I am currently back out of network. I agree with much of what has been said. “He who holds the purse strings holds the reins.” If you work for a corporation, even to be reimbursed by one, you are owned by them.

    Every physician I’ve ever met started into medicine because they wanted to help people. If society were wise, it would develop a system that supports us in taking care of them, not attack us and distract us and penalize us for taking care of them. Our society is sick because corporations run the show. To a corporation, a human being is just a resource. They even admit it in their human resource departments. The solution to the problems brought up in this article and in the comments as well, as I see it, is for physicians to organize.

    We need collective bargaining. Not for wages, as, ironically, if a group of self-employed people band together to do collective bargaining, they violate price-fixing laws. But to bargain for quality patient care, to bargain for supportive social systems that free us to take great care of people.

    When you contract with an insurance company, you are signing a contract that gives incredible power to a corporation that is greedy and heartless. Blue Cross/Blue Shield are now profiting seven dollars for every dollar they spend on post-payment audits. At that rate, why not audit the entire world? And they will. What you write in your chart won’t save you. They will always find something to ping you for. This activity is in violation of ERISA but requires court battles to get any enforcement. We need collective bargaining to go up against these huge corporations with limitless legal resources. Our medical associations won’t help us as they are the ones who gave the insurance companies the criteria that they are using to cut us off at the knees.

    There are many reasons to have a collective bargaining physician organization. To bargain for patient rights, to bargain for fair treatment by insurance companies, to investigate charges of fraud (that the insurance companies make and investigate their own charges of fraud is an intolerable conflict of interest that is obviously illegal,) to bargain for the rights of physicians against corrupt hospital administrations, the list goes on.

    The real question is: What is stopping us from organizing? How many more of us must burn out? How many more of us will have to give up patient care to escape the paperwork burden? You specialists are trapped. You cannot reasonably go out of network with insurances and expect to charge your patients what you are used to making (unless you’re in plastics.) You need to organize. There is no reason why we cannot have a system of medicine that supports us and encourages us to do excellent patient care and pays us reasonably for doing it. We need to take the reins.

  • Suzi Q 38

    There are more patients that are willing to write that check for a good doctor than you think.
    I am one of them. I see what my insurance company, Anthem Blue Cross, pays my internal medicine doctor.
    As entertaining and pleasant as I am, we have no time to talk about the virtues of a good diet for my borderline diabetes.
    He is so amusing…just tells me that I am “WAAAY too fat”
    rather than taking the time to gently explain that my blood sugars were higher partially due to the fact that I was overweight.
    I have known this doctor for over 12 years, and I would be willing to pay him directly if he would accept slightly more than what my insurance would pay him.