Saw this shared on the RadOn forums yesterday. Written by a surgeon but very relevant for all specialties:
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"We doctors, the engine which is moving the medical machine, have almost nothing to say; we have been reduced to peons. Of course, the patients, those for whom the machine actually exists, had never much to say, were forever peons. They were always led as herds to the water; the ignorant greedily buying the prevailing propaganda that “this is the best medical system in the world”; the wealthy (who by natural selection are a little more informed) understood, they still do, that money buys the best care. That it is if you are informed and lucky.
Managed by armies of administrators, managers, and hordes of non-medical parasites with a myriad of ridiculous titles printed on their name tags, they function like mammoth factories in China—albeit much less efficient. In fact, the hospitals’ pyramid has been now inverted: the supporting staff greatly outnumbers those who come in touch with the patients. In many smaller hospitals on any given day, there are more administrators in the hospital than patients.
Lip service to alleged excellence is the religion
d’jour. We are the best, we are the center of excellence, we have the best doctors, the best technology, and we are the national leaders. And this optimistic message (ala’ the forced optimism prevailing in Soviet Russia of the 1920s) is pushed forward by trained masters of propaganda—look at the size of public relationship department in even small hospitals. Glossy brochures by mail, colorful internal newspapers in any small hospital, group pictures of smiling, satisfied nurses, letters from extremely satisfied patients, and “major news,” glorifying the new Vice President of Finance or broadcasting the important speech our CEO gave in the national meeting of hospitals managers. Like North Korea. Doctors have little significant role, if any, in the conduct of the hospital.
There is no much place for dissent. You are not happy with what you see, you see problems, you want to openly discuss areas of dysfunction or misconduct, then very soon you are marked as a “problem maker.” An enemy of the system. Your fate is decided behind closed doors. The “open” process is brief and unilateral. It is easy to manufacture accusations against you: doctor, you have been disruptive, didn’t you complain against the management? The head nurse in the emergency room (ER) reported hearing your ranting?
And once they decide to get rid of you, you have not many options. They always tell you: either you resign immediately or we will have to fire you. In that case, we will have to report you to the National Practitioner Data Bank (NPDB). Now, who would choose to be tattooed with such a permanent stain on one’s record? Who would want to embark on a costly and (usually futile) legal fight with the mighty hospital? Better sign the resignation, find another job, and move on. Doing so, you sign a secrecy term that you will never disclose to anyone why you left. You will never share the problems you have observed.
Yes, we doctors have now become “providers.” In many places, our services are performed or duplicated (so the TMS believes) by “allied providers”: nurse-practitioners/physician-assistants. This obviously benefits the TMS: first, allied providers are much cheaper to maintain; second, they are less confident, and thus tend to order numerous extensive investigations (great for the system!); third, they are easier to discipline and keep in line.
This is not new: emerging totalitarian systems always start with eliminating the elite, the
intelligentsia. People who are able to think freely are perceived as enemies. Chop off their wings. In such system, there is only one higher class: that of the dictators and their cronies. All the rest are to feel non-significant and in constant fear.
The
younger generation of docs did not know better times. They, the Nintendo kids, grew up in a politically correct environment, groomed to succeed. And they know how to succeed within the TMS (they do not know any other system): obey the rules, forge happiness, and be useful. They are used to be constantly monitored by the “big brother.” They do not have a problem being evaluated/scored by faulty and biased and costly and contra productive commercial systems aimed at showing what patients think about them.
As usual, there are docs who move over, becoming the
politruks or
apparatchiks for the TMS. We all know those types: once they are allowed to sit along the long conference oak table, once they are made privy to the systems’ secrets, they are charmed to become collaborators, forgetting the interests of their old buddies. Alleged power and the sensation of self-importance are addictive for some. Isn’t it better to be fed from the hands of the oligarchs than suffer with the plebs?
This all may sound to you superficial, crazy, subversive, exaggerated, and overly dark. Well, perhaps I have exaggerated a little. And of course out there are still islands or reserves of good medicine. We all know surgeons and doctors and even administrators (and hospitals) who keep the light glowing against the background of the darkening sky.
A general surgeon (I am not going to sign this document. I still need my job for a few years …)"
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