This is Personal: The Patient-Physician Relationship

PGY 40, Day 344

"This is Personal: The Patient-Physician Relationship", was written by me and it is, simply, my opinion ... perhaps not? 

I sent it to the Veritas Health Care Working Group on June 8, 2013, and it is posted here so anyone who wishes can read and respond.

TO: Veritas Health Care Working Group (VeritasHC.org)
From: MFM
Regarding: This is personal.

Please respond, be critical and tell us about your personal experiences inside "The Business of Medicine."

Thanks,
MFM
This is Personal: The Patient-Physician Relationship
by
Michael F. Mascia, MD, MPH

Why would I put my life in the hands of someone whom I do not trust?  Why would I put my life in the hands of a Physician who is forced to cut corners on care by hospitals and third parties?  Don't do it!  Elective? Put it off.

I work with all the casualties ... I see the ones that come in off the street and I see those that come from the hospital.  What I see is very disturbing.  It is NOT RIGHT and it has to change.  Help us change it.

Picture this: Imagine you are the patient. You come in for elective surgery first thing in the morning.  Your attending anesthesiologist is with you and there are no records to reflect preoperative clearance.  He has 2 other patients ... 2 other cases to start at 7:15 ,,, the same time your case is scheduled to start.  So he is hustling and he has little help.  Your "anesthesia provider" is an inexperienced resident and the attending anesthesiologist has to teach and verify that everything is done properly to minimize the risk to you. And, the anesthesiologist knows this: standards of care dictate that certain information in addition to his history and physical is required to meet BEST PRACTICE STANDARDS.  These STANDARDS also dictate certain preconditions.  But the anesthesiologist does not have that information ... he requests it.  And ... your blood sugar is a little high ... got to bring it down before we go.  And, we have to make sure we have blood available in case of a disaster.  Big surgery = high risk.

BUT, the factory pushes ... all eyes are on this anesthesiologist ... because he is SLOWING THE LINE DOWN.  Yes, that's right, you are being treated like a hunk of meat on a production line.  That's the way you are seen ... A HUNK OF MEAT BEING PROCESSED ... and, God forbid the Anesthesiologist hold up the line, or STOP THE LINE for the sake of good OUTCOME.  Yes, I have been that anesthesiologist and when I work that line, I put myself in the position of the patient ... that is the only way to guarantee BEST PRACTICES.  But, if I stop the line, I become "THE PROBLEM" and all the pressure is on me, and they just want to REPLACE ME with someone who does not know any better.  They call this "Production Pressure" and it is an evil reflection of Profit over People that is rampant throughout US hospitals ... every day ... across the country.

Yes, the Business of Medicine in conjunction with third party payers has violated our trust.  By undermining the Physician, they undermine the Patient-Physician Relationship and "Best Care" in favor of Profit.  We all feel it and some of us know it.  That's why everyone I ask ... Patient, Physician, Nurse, other provider ... is disgusted by it.  And, that's why Veritas Health Care is working to create alternatives to Business as usual in Health and Healthcare.

It is the allegiance between patient and physician, and yes, the strength of the bond between Patient and Physician that dictates the healing power of the Patient-Physician relationship.  Over the last 30 years, third parties have systematically disrupted this bond, in favor of "medicine by the numbers", corporate doctoring, third party power and profits over patients.  There is increasing awareness of the problems

Veritas Health Care recognizes the values of the physician-patient relationship and is dedicated to supporting others who value it.

This is personal.

Please join us.

We have tools that will help you Take The Best Care™© of yourself and we will teach you how become an equal member of the healthcare team ... how to help your doctor Take The Best Care™© of you, if and when that becomes necessary.

Dr. Mike

Why are Hospitals Dangerous? The Business of Medicine

The Daily Apple™© Volume 2, Number 4

Wednesday, March 6, 2013 PGY 40 Day #249

The Daily Apple™© Volume 2, Number 4

From Dr. Mike & Infinity Health Solutions

www.ihealsolutions.com  

Why are Hospitals Dangerous? The Business of Medicine

Why are hospitals so dangerous?  Is this a new problem, or worsening of an ongoing problem? How do we fix it?  This is my take on the subject.

During my career, I have watched the Medical Profession fall into a trap driven by The Business of Medicine.  Yes, that's right, it is all about money.  When I started, it was not easy to do the right thing for patients, but we did it.  The Medical Profession, the Art of Medicine and the Doctor-Patient Relationship were important considerations at that time.  Now, for many reasons, dwarfed by the focus on money and business, the Doctor-Patient Relationship has been sold out to the Business of Medicine.  Let's take a brief look at the problem and the fix.

Patient care has never been and will never be perfect, so Quality and Performance Improvement (QIPI) have always a part of what we did to take stock of errors and bad outcomes.  At the start of my career, QIPI generally took the form of Peer Review and Morbidity and Mortality (M+M) reviews.  The traditional reviews of adverse outcomes were strictly medical, mostly confidential and Peer Review has generally been undiscoverable as well.  These processes were not strictly scientific, because they only looked at the cases that surfaced.  Generally they focused on deaths and major adverse events which were perplexing or major errors.  We all learned from these case conferences and, having been actively involved from the start, I learned how to turn the QIPI process into a scientific way of monitoring quality and outcome of care, and how to make care better and best.  So, I have been watching Quality and Outcome in healthcare from the start of my career and I have watched the deterioration over time.  This is what I have seen.

Over time it has become progressively more difficult to focus on the patient first and the Doctor-Patient Relationship.  At this stage, third parties have so much control over the profession, that it is virtually impossible to stand for patients, because the Profession and the Doctor-Patient Relationship have been hijacked by third parties that hold the money.  If a doctor stands up for patients and, in the process slows "the line" down, he or she becomes the identified problem.  The "real problem" gets lost in the shuffle.  Now, the business people drive Doctors to "perform" and that often puts Profit over People.  As the money holders push Patients into "product lines" and Doctors into "line workers", the human factors and rough edges are dismissed, and corners are cut for the sake of "efficiency".  That translates into running patients "through the mill" as fast as possible to "save money". 

Nothing wrong with saving money, right?  But, think about it and look at the facts.  In fact, when we "save money", it does NOT go back to patient care, it goes to third parties who care only about profits and bonuses.  Consequently, the bottom line is this: corners are cut, quality of care goes down, people are hurt and third parties get more money.  That money comes out of the pot that should be used to improve patient care, and goes into the pockets of corporations, share holders, executives, managers and other folks who do not care for or about patients. 

This background sets the stage for deterioration of patient care in hospitals.  As corners are cut and fundamentals are ignored, the most vulnerable of the vulnerable, our patients, become the victims.  Pushing for speed over quality under the guise of efficiency and "cost containment" has interfered with good old fashioned basics of quality patient care.  Generic 'benchmarks" have lowered quality by creating a group think mentality that reinforces bad care as acceptable.  Why? Since we look at hospitals as they compare to each other, standards are lowered to "we are all bad together" levels, instead of reaching up for better and best care.  Hospital QIPI programs are sluggish, disconnected from front line providers, not transparent, dysfunctional at best, and do not come close to the scientific scrutiny required to build the best possible care.

What's the fix?  Objective QIPI and Improve Quality First (IQ First™©).  StepWisely®™©, IQ First™©, Rational Cost Containment™©, Top 10n Targets™© and STOMPPIT™© are each parts of our QIPI Tool Kit™© .  Our Quality Improvement systems are designed to engage Doctors, other care givers, Patients and Families in the processes of improving patient care from the front lines of Patient Care.  When Doctors and Patients unite to drive the QIPI process, we will make hospitals and other health care providers as safe as can be ... we can make each one of them the "best" in the context of the community in which they live.

Join us.  Let us help teach you how to make your hospital stay safe and your local hospital "the best".

Please comment on this blog, or email dr.mike@ihealsolutions.com

Dr. Mike