Mission: Healing, July 2, 2011, PGY 39, Day 2 Continued

Here it is! My post to American College of Physician Executives discussion from today. We will see what I get for responses.
Dr. Mike
This is PGY 39, Day 2 for me.  That means Post Graduate Year 39 (after medical school) for those who are unfamiliar with the term.  PGY 39 ... WOW!  I remember the day I graduated and the day I took the oath.  Things have changed, but I still take that oath seriously.
Running the SICU service with two PGY 1s (AKA interns) and some back up from PGY 2s and 3s.  We get the job done despite the distractions.  How?  Focus on the Mission.  What is the Mission? Healing; AKA Patient Care.  That is the only way I can keep inexperienced house staff and nurses on target to provide comprehensive quality care.
Do we talk about money? Yes.  Do we talk about Quality and Performance?  Yes.  Do we talk about the needs of the providers?  Yes.  But, all of the conversations not central to providing optimal patient care are secondary to our talk about specific patients, their needs and the needs of their families and loved ones.  We engage everyone in the process of care ... patients, families, docs and support staff ...  all the folks who help us care for those patients.  They all help us to stay on target with the mission, goals, objectives and the process of providing optimal care for OUR patient.  It works ... it is hard work, but it works and it is the right thing to do and it is rewarding.  Not for the money, but for the pleasure that comes from doing the right things for these folks who need us.  It is about love ... there is not enough money to endure the stupidities that have grown into great obstacles and barriers between Doctor and Patient.
Yes, it all gets harder as the complexities of care grow ... not because patient care is harder, but because increasing numbers of various (removed from the front line) third parties impose more and more tasks and distractions that detract from our efforts to accomplish the mission.
How many of you work the front lines?  How many of you feel "production pressure"?  How many of you work for a "Physician Leader" who is pushing you to cut corners on Patient Care and Patient Safety for short term $$$ gains and profits?  How many of our "Physician Leaders" work the front lines?  My bet is that there are very few of us out there.  And, how many of us who work the front lines have a significant voice in driving the health care machine that we work in?  I suspect very few have a say.
What does that have to do with anything?  Get out there and try it ... try breaking away from those closed door executive meetings and get yourselves embedded in the front lines.  You might learn something about the needs of the patients and front line providers.
Think about it, and think about this: This is the time for a new paradigm ... or return to the old paradigm.  Return to the fundamental practice that is the DOCTOR - PATIENT relationship.  Simplify ... get the third parties out.  That would save 30 - 60% of each and every health care dollar.  If you don't take care of patients, you have no business making decisions about how patient care is provided!  Get out!  And, those of us on the front lines will have to carry some necessary administrative burdens.  Such is life as it should be, in a DOCTOR-PATIENT driven health care system.  
I sat at one of my obligatory hospital meetings the other morning.  During the usual boredom, I counted the number of people there who rarely, or never take care of patients.  They have created a bumbling and very expensive bureaucracy to justify their own existence.  What for? To deal with the complexities created by other third parties that never take care of patients.  This is the BUSINESS OF MEDICINE and not the PROFESSION OF MEDICINE.
The business of medicine is not equal to, nor does it have the capacity to provide optimal patient care.  In other words, the BUSINESS OF MEDICINE does not equal GOOD PATIENT CARE.  There are too many gaps and obstacles in the production lines (product line/factory mentality) designed to make money ... forcing doctors to become line workers who work on their patients for the sake of the company.  The Healing Mission ... the Human Factors ... are lost in the confusion that ensues when we chase the money.
That approach can never work, because it is designed to make money and not designed to provide individualized care to patients and families.  The HEALING MISSION can only be accomplished through the bond between DOCTOR and PATIENT in the context of their FAMILY.  Why did we let this happen?  We followed the money!
Let's try something different.  I believe the time is right for a new paradigm.  LET'S START a NATIONAL NON PROFIT DOCTOR - PATIENT COOPERATIVE.  Build greed out of it.  Cap salaries and eliminate profits.  Put all money back into care, and "profits" back into the hands of the members.
My sense is that about 5 - 10 % of the patients we serve are interested in being active participants in their health care.  That is a large number of people.  And, according to my calculations, that could, over time, create a large enough population base to enable development of a NATIONAL, or INTERNATIONAL NON PROFIT DOCTOR-PATIENT INSURANCE COOPERATIVE that could fund itself for routine care and buy, or create catastrophic back up coverage to be used anywhere.
Idealistic? Yes.  Possible? Yes.  Anyone interested? Let me know.  I need a few good, experienced, dedicated and courageous docs (and patients) who are ready to work with me and to take a step into the unknown for the sake of the patients we all serve ... and for the sake of the profession ... to honor the oath that most of us took upon graduation from medical school.  You have little to lose and, perhaps, we all have a little something to gain.
Dr. Mike

MFM@IHS ip