Something’s rotten in America’s health care


My friend, the hospitalist, was livid as he came from meeting the administration. “They said doctors cost too much!” he sputtered. “We’re an expense. An expense the hospital can no longer support. We are an expense!”

He turned purple. Nice color. Like a good Bordeaux. I worried about his blood pressure. He can’t have a healthy lifestyle! None of us do. Seven twelves in a string will do a number on your workout routine, your family life, and your sanity.

“I wanted to ask: Why do you think patients come here? To see you? To see what you concoct while sitting in your office popping M&Ms? They are here to see doctors. We care for the patients. We make you money. It’s our work that gets you paid! And we cost too much?”

To that I’ll add:  When was the last time you saved a life? It still matters a little.

Medicine changed. Remember the family doctor driving his horse-drawn buggy for home visits? Delivering children, letting blood, and getting paid in chickens and honey? Neither do I.

That was BOE. Before our era. Before hospitals, insurance companies, EHR, and Obamacare. Those doctors are dead, lucky them.

You and I, we live in the Provider Era. We are no longer doctors. In our sick health care system, we became providers.

“Code 99. Provider Jones to Room 3. STAT.”

Cows provide milk. Pigs provide bacon. Farmers provide corn. What do I provide? Percocet? I&Ds? Work notes? How about you? And BTW, which provider school did you go to?

Downgrading doctors to providers was smart. It trimmed our aura, downsized our hubris, and reduced our influence. Our expectations and our pay too. It helped bend us to the regulations administrators exist to enforce. Unless it’s the other way round. Regulations exist for administrators to enforce. After all, they need to do something. And they aren’t into touching patients!

We are blessed with administrators for every taste. CEOs. COOs. Quality coordinators. Facility planners. Compliance officers. Human resource managers. Risk managers. Trauma coordinators. Patient care advocates. Coders. Education specialists. I’ll keep it short since some of us actually have to work.

They wear suits. We wear scrubs. They smell like aftershave and cologne. I smell like patients and stress sweat. They talk Medicalese. I talk ER. Their job is to tell us what to do. Like:

  • Fill out ALL forms.
  • Check ALL the boxes on ALL the charts.
  • Obey the latest genius rule hatched by CMMS.
  • Give antibiotics even before we know if somebody’s sick.
  • Kiss JCAHO’s cheeks.
  • Have no drinks at the desk. Coffee, I mean. What were you thinking?
  • Give drugs to those who say they have pain.
  • NO! STOP! Don’t give them drugs! You’ll make them all into addicts!
  • Be nice to families. They’re always right, even when they spit on you.
  • Be nice to patients. They’re always right, even when they bite.
  • Decrease overtime.
  • Are they safe at home?
  • Any spiritual beliefs we need to be aware of? Do they need a shaman? Get a shaman.
  • Do they need a translator? They speak English? So what? Ask anyhow.
  • Are they suicidal? Homicidal maybe? A sprained ankle does not protect them against suicide.
  • Do they drink? What? How much? How often? Would they like to stop?

Thanks to the administrators’ care, no patient with a stubbed toe fails to get his religious beliefs recorded, his drinking evaluated, and his spiritual needs cared for. That’s what they do.

We are the Touchables. Nurses, Doctors, PAs, NPs, CAs. We touch patients. We touch their bodies. We touch their lives. We touch their deaths. We tell them that their mother died, their kid has drowned, their husband will never walk again. We tell them they’re dying. We put a stethoscope on their chest, a finger in their rectum, a tube down their throat, a hand on their shoulder. We hug them if they let us.

Sometimes they touch us. They touch our souls. We spend nights wondering what happened to them. We wonder if another doctor could have saved them. They touch our bodies. They hug us. They shoot us. They punch us. They cut us with the blade in their bra. Our scrubs and our minds are forever stained with their blood, their poop, their sorrow. We inhale their smells, their viruses, their misery.

We’re touchable. Expendable too. We’re the foot soldiers in the health care war.

Administrators are a different breed. They don’t touch patients. They don’t draw blood; they don’t clean poop; they don’t get hurt. They don’t lose their jobs when things go bad. They have scapegoats. Us.

They proliferated like mushrooms. Or like a cancer. So did health care spending. Any relationship, you think?

You can’t swing a dead cat without hitting an administrator. That’s comforting as long as you have enough dead cats.

As for doctors? Unless you’re bleeding to death, you’ll wait for months for an endoscopy. Same for neurology, urology, ENT, ortho, and any other specialty.

We got far away from those touching patients making decisions for their care. We’re ensnared in a net of rules and regulations compiled and enforced by untouchables who would do anything to keep their job. Anything but touch a patient.

Something’s rotten in America’s health care.

Rada Jones is an emergency physician and can be reached at her self-titled site, RadaJonesMD, and on Twitter @jonesrada. She is the author of Overdose.

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