Mission: Healing September 24, 2011

PGY 39, Day # 86

Medicine by the Numbers is Painting an Unacceptable Picture ... Strike that

Medicine by the Numbers: Painting an Ugly and Unacceptable Picture of Money and Profit Over Patient Care

These are not new thoughts for me, but, rather recurrent thoughts ... triggered by my observations on the front lines of patient care ... and the picture gets worse ... and worse with every passing day.  With every passing day, it gets harder and harder for the front line providers to give the best possible care.  It is a struggle to say the least, and the bottom line is this: The Business of Medicine DOES NOT equal The Profession of Medicine and The Art of Medicine, and therein lies the problem.  Business guys want to earn money, and Doctors want to ... and are obliged BY OATH to take care of patients.  So, as I see it, the Profession of Medicine ... the Doctor Patient Relationship ...  has been hijacked by the Business of Medicine, so patient care providers are only valued in so much as they can generate $$$ for the business.  In other words, the Business Guys are riding on the backs of patients and providers (AKA the Doctor-Patient Relationship), driving the Doctor-Patient Relationship toward the MONEY, skimming off the top (30-60%) and Patients are falling through the cracks, because their health care needs are not being met.  It is Ugly, Unacceptable, Unethical, Immoral and probably, if not illegal, on the edge of legality. 

But these Business Guys do have excuses for their bad behavior, and they are protected by corporate structure from the bad outcomes that they produce in the process of driving the line toward greater "productivity" and pushing providers into situations that result in cutting corners and lowering quality.  What do Business Guys know about quality patient care?  Nothing!  Do they care about patient care?  No!  They care about the bottom line, profits, bonuses, money in their pockets and corporate profits ... that is their business.

I have posted a Top Ten Target ( TTnT(TM)) Solution List in the past, and I will post it again in my new blog, but for now, I  will share the piece posted on my website blog ... in November 2008.  As you review this post, keep in mind one simple fact: The Business of Medicine DOES NOT EQUAL The Profession, Practice and Art of Medicine.  Therefore, The Business of Medicine DOES NOT & CAN NOT PROVIDE for optimal patient care.

"By Dr. Mike Nov. 26, 2008 at 11:10 pm EST (Updated Nov. 26, 20

08 at 11:10 pm EST) 

Medicine by the Numbers is Painting an Unacceptable Picture

Do you remember those “Paint by the Numbers” kits we used when we were kids? Have you ever used one? Have you seen the results? Sure, on the cover they show a masterpiece partly completed to perfection by the numbers.

Then, you or your child eagerly rips the kit open in anticipation and rushes to create your own copy of the masterpiece. You paint away by dutifully dipping your brush into each little container and carefully applying each color in the proper spot … yes, “according to the numbers.” After hours of careful work you have finished … ah … and you hold your finished product up to stare in admiration … only to find that you have created something that, at best, only grossly resembles the masterpiece. The finished product is most likely gross; a very disappointing and poor representation of the real masterpiece upon which the kit is based.

When I stand back and look at the products we deliver in American medicine today, it is only rarely that I see a true masterpiece … the work of a master craftsman. Frankly, I am often grossed out by what I see. Why? Currently, American Medicine is done “by the numbers.”

What do I mean? Modern American medicine is driven by reimbursement and not by patient needs, so many patients fall through the cracks. Hospitals and other care systems have clearly been forming their organizational structures and operational strategies based upon the “return on investment” and other production principles … the same business systems that drive factories, assembly lines and factory workers. Nothing against return on investment, production principles, business systems, factories, assembly lines and factory workers, but the model simply does not work in healthcare.

When I started working as a Critical Care Anesthesiologist at Tulane University Hospital in 1999, it soon became apparent that patients were being treated like hamburgers in a fast food chain, and I often said, “They treat patients like hamburgers … as if they were all the same … as if they all needed the same treatment for the same diagnosis.” I would say, “Imagine trying to run an airline … with 100% special need customers. It could not be done. But, each patient is a special need customer.  Patients don’t fit into the cattle herding and hamburger production models, and that is one of the reasons why many hospital administrators have no understanding …

(CONTINUED(C)MFM@IHS)"

This outrageous situation can and must be fixed.  I will share my "Open Letter to President Obama" that I posted soon after his election, so you too can see my suggestions for moving back toward a more health and healthful health care system.

To be continued ...

Dr. Mike