What’s happening in the hospitals?

And not just in the emergency rooms and intensive care units:

Doctors learn the business of the body, not the business of medicine. But modern health care is an industry with a bottom line measured in dollars, not wellness. As we train, we’re told to “stay in our lane”—an important lane, to be sure—and just worry about being good healers. The rest, the pesky business of how the wheel turns, can be managed by the rapidly expanding pool of administrators. In “staying in our lane,” we don’t feel the insidious ways the business of medicine has eroded the value of the doctor-patient relationship. Instead, patients have become a commodity and physicians a cog. We’re blind to the chaos and danger around us. We might note how focused administrators are on metrics of efficiency and patient satisfaction scores, even if efficiency doesn’t mean quality, and higher patient satisfaction scores are linked to higher overall mortality rate. But we’re hired to provide the services approved by the hospital, and insurers, which is frequently not to our own standards of patient care.

I see this dynamic continuing in the midst of the COVID crisis. As hospitals and politicians continue calling for help in public, the rhetoric has been that there are too few doctors to manage the crisis. They said this even as doctors were fired or told to leave midshift for wearing their own protective equipment. Colleagues who were pointing out dangerous practices for both employees and patients were asked or pressured into leaving. Colleagues who were lower risk and looking for fairly paid work were passed over because other health care workers—who were made to believe there were no other doctors available to work—were being brought in as unpaid labor. They were told there was no money to be found, despite high reported revenues and administrative salaries in the multimillions.

Much more at the link; look for the April 17 entry, which is the most substantive part.

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