The void between physicians and administrators in hospitals

In a hospital setting, administrators love to work with physicians; they make sure whenever a new system is being formulated and implemented, this is discussed with a team of physicians, as they are also an integral part of success. All physicians work with each other in harmony and synchronicity.

Cardiologists never step on each other’s toes, radiologists call admitting doctors for any bizarre findings and hospitalists notify the primary about their patient’s update.  Physicians discuss their plan of care with nurses and nurses in turn make sure all support staff is conveying the same message to the patient. Nurses keep a direct contact with their assistants, physical therapist etc and they inform each other about any significant changes.

And … by now I usually wake up from sleep and face the nightmare of reality.

There is no “I” in a team. I often feel that there is a desire from everyone to work as a team, but we all work in our little domains — administrators do their own thing, physicians after seeing a patient do not see the big picture and nurses immerse themselves more in entering data rather than reviewing what data means.

In every hospital I have worked at, there is a huge void between physicians and administrators. I often feel a free flow of information and mutual trust can reach goals better than a “need to know” policy.

On one hand, one half of physicians do not get along with each other. There is constant bickering about stealing patients and how unethical the other doctor is. Please do not take me wrong way.  I have my moments of bickering too but I try not to. If a primary decides to use another physician to admit a patient other than our group, I try to self evaluate ourselves and ask why did this happen — were we doing something wrong or was it a purely business decision from primary care? And if it is the latter, then it is a free country.  I believe in free will and enterprise.

I call this overall behavior “maximum of minimum attitude,” where you do the minimum best among our own domains and seldom cross over. I think we need to put more emphasis on teamwork. Workshops among all hospital based personals should be encouraged.  We need to emphasize on the bigger picture rather than our cocoons.

There needs to be one hero everyday rather than one hero all the time.

S. Irfan Ali is a hospitalist who blogs at Human Factor in Medicine and Life.

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