We shouldn’t need the permission of administrators to heal ourselves

David Bornstein did a real nice job in his New York Times column, Medicine’s Search for Meaning.   He partly captures what it is like to walk in our shoes.  This is not a pity party for doctors.   It is a limited look at some of the stuff that tears us up inside.  He explains nicely the damage we have to absorb to get to the pinnacle of our careers only to see it fall apart due to burnout.   He then goes on to discuss a course called “A Healer’s Art” which really seems pretty intriguing.  

Here is how it described:

The Healer’s Art is predicated on the idea that medicine is an ancient lineage that draws its strength from its core values: compassion, service, reverence for life and harmlessness. When students and doctors connect to these values in a community, they derive meaning and strength, and can “immunize” themselves against the assaults of the medical curriculum and even the health care system itself.

So, why isn’t this kind of thing more accepted?   I mean the description above could be described as Authentic Medicine.  The answer lies in loss of autonomy.  The problem is that physicians have none.  Many of us wish we go back to the time where we could connect with patients more.  That is so far behind us now that is laughable.

So no matter how much a course like this may make the doctors think they are “immunized against the health care system” they will be reminded of it the first day they are back in the clinic.  They will be reminded of it every time they rush through a patient visit who has 5 issues to be discussed in a ten minute appointment.  They will be reminded of it every time an administrator puts a new and useless mandate in place.  They will be reminded of it every time they get bogged down in a bloated EMR chart.  And on and on.

Pretty soon all the good will of the course is forgotten as the stress of the job comes right back.  You see, the easiest part of the job and the most fun part of the job is actually seeing and treating the patients. Unfortunately, it is the unbelievable amount of bureaucratic drag that tears it down to a point where everybody wants to quit.

Do you think I am wrong?  Bornstein goes on to say the following:

However, if hospital administrators are going to allow doctors to cut back on “productive” activities so they can take time to focus on self-care, he adds, “We’ll need to provide hard evidence for people making financial decisions that this is a good investment.”

Hospital administrators allow?  He makes this statement so matter of fact that he ignores the obvious. Hospital administrators have to allow us to heal ourselves?   That, my friends, is what is really wrong with heath care.

Doug Farrago is a family physician who blogs at Authentic Medicine.

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  • Ron Smith

    I guess I’m shielded by private solo practice. Though I started 30 years ago in private solo Pediatrics and did level 3 neonatal intensive care as well, I stopped going to see newborns in the hospital about 7 years ago. Mostly this was because of the 75 miles I could cover just in the morning commute between three hospitals, but just as much because the time spent at the bedside trying to connect to new moms with the babies was not very satisfactory.

    Now I see them within the first 5 to 7 days after they go home. I connect very well to these families and spend much more quality time with them. I also get to correct much of the misinformation that is flowing from the hospital stay, particularly to breast feeding.

    If anything, not having hospital privileges has freed me greatly. I am doing the best job ever. Our clinic is pursuing level 3 Patient Centered Medical Home certification, something that only 5 practices have in Georgia.

    I think doctors can have autonomy. At least in private practice. Especially solo practice. But then solo practice was the way it all started, too.

    Just some thoughts.

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • southerndoc1

      Sounds like your practice is working well. Why in the world do you want to go for PCMH certification?

      • Ron Smith

        There may well be remuneration differences in the future. No one knows for sure at present. There are many things we are already doing that are part of the PCMH certification, but we want to also be on the cutting edge of defining what are the standards for PCMH. We have ideas about patient care that we can bring to the table and improve patient care.

        Almost daily we get comments about how high tech we are in the office. Caring the PCMH certification, I think, is something that parents can connect to in a similar way.

        That is different from meaningful use for which parents and patients have no understanding or use for really. (And neither do I for that matter. Meaningful use means nothing in relation to patient care.)

        I think it will be good for the patient care, good for the practice, and good for the PCMH standard as it continues to develop.

        Medicine is changing and I want to see that baby is not tossed with the bath water. I’m an old doc, but I’m not old in my thinking or my desire to do better for the kids and families that I care for. And I really do care for them, that is not just blah, blah, blah.

        There are only 5 in the state of Georgia so I am on the cutting (bleeding) edge. I was that way when I designed my EMR in 2000 long before everyone was moving in that direction.

        Ron Smith, MD
        www (adot) ronsmithmd (adot) com

        • southerndoc1

          Thanks for the reply.

          I’m less optimistic than you about expecting NCQA et. al. to pay any attention to practicing physicians and make the certification any more relevant to patient care. It appears that the standards are already becoming even more bureaucratic and administrative top-heavy. Seems like a terrible waste of time and resources to me.

  • Dr. Drake Ramoray

    This article misses the big picture in that physicians are increasingly becoming hospital or corp med employees in the first place. Newsflash, if you work in a hospital or health system you are an employee. Perhaps a very well educated employee but you are still a human resource within that corporate entity. This one fact will impact your practice of medicine in very subtle and very obvious ways. You don’t have control. You are an employee.

    Yes there is a squeeze for time and money going on in medicine. Even outside the corporate/health system entity I still find myself strapped for time. Usually because of obnoxious insurance companies and peer to peer reviews required for testin and treatment (that is if my peer is a nurse who barely speaks English, has no training in Endocrinology, and doesn’t know the first thing abou treating thyroid cancer). Of course by the above logic I have accepted seeing people with health insurance (much like employed docs have accepted the condition of employment).

    In conclusion, if you don’t want to be a corporate drone you either go concierge, start doing clinical research, or give up your hospital privileges (at least in my case).

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      How does giving up hospital privileges help? Is it just the fact that you don’t have to deal with them at all, or are there more reasons?

      • Dr. Drake Ramoray

        If the physician in question is in a private practice then there are no administrators to deal with if they give up hospital privileges. (Still the insuance ones as I mentiomed above). I know several Endocrine practices that have converted to outpatient only.

        My group is small and has one office manager If we want more time for patients or Friday afternoons off or whatever, as long as we can afford it we can do it. I do not require a “by your leave” from some bureaucrat who has need take care of a patient in their life before.

        That being said private practice has its own headaches, but those are beyond be scope of this article that if you sign on as an employee you are an employee so don’t be surprised when management treats you like a “human resource.”

        This is opposed to where I infer worked where new visits were 30 minutes and returns were 15 minutes. There was talk of changing it to 20/10 when I left, patient care be damned.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie


      • ninguem

        I have yet to meet a primary care doctor that has regretted giving up hospital “privileges” (really burdens).

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          Not that hospitals or anybody else cares, but isn’t this perhaps less optimal for sicker people, than seeing your own patients in the hospital (and I don’t mean be employed by the hospital)?

          • T H

            Family Medicine docs have taken a lot of hits over the last couple decades and there’s no reason for them to keep letting themselves getting abused.

  • buzzkillerjsmith

    Different docs are different, but for me the most efficient and the quickest way to destroy my morale is to be an employee of a person trained in business. I’ve worked in that situation before and sincerely hope I never will again. Business and feds of course want us all in the corral.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Well yes, because if you get the alpha to go in, all other dumb animals are as good as cash in the bank…

      • NPPCP

        No doubt! That’s why this alpha owns their own practice!

  • Jess

    “We’ll need to provide hard evidence for people making financial decisions that this is a good investment.”

    Welcome to the world of being a mere employee. If you’re going to throw your lot in with Corp Med, you’re going to be treated just like an employee of Corp Widget or any other large Corp.

    You can’t have your cake and eat it too, and you can’t sell your independence and have it too.

  • Lee

    Having been brought back from near death on a number of occasions, most recently during my treatment for Stage 3 throat cancer and subsequent life-threatening infection, I owe my life to medical professionals like you and your colleagues. When I was at the end of my treatment and a very low point physically I was hospitalized with that life-threatening infection I was subjected to “care” vs treatment, that was so inhumane, so insensitive, uncaring, and lacking in compassion that I was thrown into a deep, deep depression that led me to seriously consider suicide and wish for death at a minimum. I am absolutely certain that those healthcare professions were not bad people and not intending to produce that result. It was clear that they were angry, frustrated, and stressed by what I now know to be a plethora of very real and trying circumstances that you so accurately describe here that lead to desensitization, burnout and often, for doctors, suicide. However, it is never, ever good business nor good medicine to allow those very real challenges to be taken out — even accidentally — on one’s patients. It’s not who you are as professionals and most certainly not why you got into the business of medicine in the first place. I KNOW that from my many other amazingly good medical experiences. As a customer service expert, this is not only bad for patient outcomes, but horrible for business. I can tell you that the hospital where I was treated will never, ever get my business again, from me or my family. (Which given my medical history is like to occur, sooner than later) I will spend my life telling others of my experience and trying to prevent them ever going there. I’ve blogged everywhere to warn others of what they might expect there. And, if I had the strength, I’d try to figure out how to sue them. So, if the need is to quantify why “care” for medical professionals is essential and contributes to the bottom line, those sound like four pretty good reasons to me. And, spreading that message, once I get strong enough, is how I intend to spend the rest of my life. Compassionate care is good for business, good for patients, and good for healthcare professionals. How can I help make that happen? Oh, and P.S. Great care has little to do with the amount of time one spends with patients, but more with “how” one interacts with patients and that is a skill, not a genetic disposition. We sick patients need healthy doctors and nurses and to those who make those decisions, so do you and your business.

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