It is the comfort away from the difficulty. It is the ease away from the decisions. It is the many-imagined virtues over the many-imagined vices. The doctors are moving away in droves from being owners into being owned. The new owners cite an endless litany of the benefits; no more paperwork, no more meeting payroll, no more regulatory issues, no more complaints related to the business of things. “Its all about you’re being able to practice the art and science of medicine in peace without the headaches.” They say.
That sounds great, doesn’t it? Or does it?
I asked this of a private practice physicians looking into becoming a hospitalist.
“Yeah, but imagine, if there was a lull in the patients, I would still be guaranteed a salary.” He wrung his hands in anticipation. “I would be practicing medicine and at the end of the day, just like the nurses and the transporters and the house-keeping people, I would go home without the aide of a beeper. Just me, my world and I! No tethers!”
That did sound like a good sale of goods.
“But what about the demands of the hospitals?”
“What demands?” he raised an eyebrow.
“Well, like issues of cutting costs by reducing the diagnostic procedures and in some cases advocating against certain therapies related to age, infirmity etc.?”
“Oh, I don’t think that will affect me. Besides, I told them, I’ll practice my kind of medicine. And they have agreed to it.”
“But don’t you like being the owner. Calling your shots of when to go on vacation, how many patients to see, what type of patients to see, how much time to spend with them and their follow-up care?” I inquired.
“At this point, with all the government interference and the pressures to perform the regulatory dance, I am tired of this nonsense. Let me practice medicine and let someone else handle the headaches.”
Sounded good, the way he put it.
Anyway one year later, I met him again, this time his face was a little downcast.
“Hey how goes it?”
“It’s o.okay.” There was a hesitation in the okay.
“Enjoying it better than your own practice?”
“Yeah a little.” He hesitated.
“You seem unsure.”
“I, I am not making as many decisions as before. Something is amiss.” He said with downcast eyes.
“But you have time off, right?”
“Yes, but, I go home thinking about the procedures I did and never get any feedback from my… or… our patients, or from my colleagues in the outside world or for that matter within the group.” He said. “It appears that the 9 to 5 job environment creates a 9-5 job mentality.”
“I don’t know what you mean?”
“You know what I mean.” He chided.
I met him again two years later at a national conference and he looked unhappy.
“Hey there! Is everything okay?”
“Not so good. My contract was terminated by the hospital because of ‘productivity’.” He said, “Imagine! They cited the cuts from insurers and the cost of my care delivery to the patients. It was more like what was asked of me that I could not deliver.” He looked up with a hint of red rims around his eyes. “Now at my age, I have to look for a job or restart a private practice, which is next to impossible. DAMN them!” His arms were limp by his side and his eyes told the tale of woe, much more then the words that he uttered..
Sadness is the state of affairs when we allow ourselves to hand over our liberty and freedom to another. Where the imposed mini-hassles on a private practice makes us modulate our decisions and become stronger in our governance, these magnified hassles are forcing us to abdicate our responsibility. We are falling into the trap of a pink slip and loss of control.
Morlock (The Time Machine, 2002)
Eloi (The Time Machine, 2002)
A costly reminder lurks in this encounter. It reminds me about H.G.Wells mythic residents; the Morlocks and the Eloi living 800,000 years in the future. The elite "cared-for" and the "worker-class" complex was the premise behind The Time Machine. But adroitly H.G. Wells realized that the working Morlocks would end up attacking the elegant Eloi for their own sustenance. (again you might have a different opinion of the book)
Morlock massacre (from Comicvine)
And that reminded me of the French Revolution and the inept King Louis XVI!
Storming of the Bastille
The catch-words of today for the hospitalists are:
- Attain rapid improvement of patient satisfaction.
- Assess individual hospitalists according to patient satisfaction scores.
- Benchmark hospitalists according to patient satisfaction scores.
- Align bonuses to individual patient satisfaction performance.
- Track hospitalists’ patient satisfaction performance over time and assess performance coaching effectiveness.
This is the bureaucratic format that fills the forms, applies the binary code, assesses and then calculates the "statistical significance". All the words are carefully chosen to appeal to the sense of duty, a sense of comfort, a sense of responsibility. They are carefully weighted in the formulae to reach the ultimate answer selected prior. But that is all they are, just empty WORDS used for forcing a mindset of "cost-efficiency" and nothing else. This mindless prattle that is pervasive in the society today is a nightmare that will startle us into a bleak awareness one day soon. Today's "intellectuals" that have never practiced medicine a day in their lives, sit in their ivory tower appointed seats and perpetuate their axiomatic concepts into reality. Failing which they are eager to deploy another one.
The hurtfulness of little hassles created by the insurers and government, are constantly eroding our sense of comfort and forcing us into decisions away from the difficulties of personal responsibility in medicine, to a more corporate approved and funded program of basic utility and a bureaucratic unemotional dispatch. This is the progressive emotional runaway with nary an impediment ahead. The roads all lead to homogeneity of thought and loss of individual excellence. Where will be the Jenners, the Watsons, the Cricks, the Salks and Sabins? Will they rise above the fray of this mush that we are creating? We need the tinkerers. We need the entrepreneurs. We need the Risk-Takers. We need the fertile minds, unbiased by the mandates of imposed guidelines. We need the freedom to think and experiment and operate! We need to create. We need to build. We need to understand. And above all we need to REASON.
There are no floating islands of Shangrilas out there (maybe in our minds)...
There are no pies in the sky either (maybe in our minds)...
But there are the cold hard facts!
Maybe it will be okay under a new master?
But then again, maybe it won’t!
Time will tell…
But who will ultimately suffer is the patient, like Oliver Twist, who wanted just a little more and the doctor who wanted to give that little extra bit of time, attention and comfort…