I usually try not to “like” or share content with profanity in it, so I’ve delayed sharing this insightful letter from an angry doctor. But then my husband was filling out some medical credentialing forms this morning. He was talking to a credentialing coordinator about whether he had to answer “yes” to the question about his license ever being investigated if it was an anonymous complaint, described without specific details in a form letter, and subsequently dismissed. Of course the answer was “yes.” This exchange, and the angry doctor’s letter, give some insight into what has happened to doctors over the past two-plus years.
“We have been programmed over years in practice and throughout training to know that without strict adherence to the mostly nonsensical requirements, we will be quickly emailed ‘reminders’ about any policy in question, reprimanded, and threatened with loss of privileges, jobs, licensure, income….There is no reasoning with the machine. No debate to be had. No logic to which to appeal. Accept the policy. Any policy. Every policy. Without question. Without hesitation. With a smile on your face. Or you, are out of job, potentially out of medicine. You are free to take your nontransferable skills that took you decades to learn, and large sums of money to acquire, throw it all out the window and learn to code. They know this, and they know we know they know this….And how much contempt does this reveal from the perspective of hospitals for our training, our finite time, our money, our dignity?”
I was supervising an anesthesia resident this past week and was confessing to her how often I reveal my age by my commentary. We were bumping up against frustrating policies and procedures and I explained to her how it used to be that if I thought something was in the best interest of the patient, I was free to do it. Over the course of my career, it’s become increasingly and frustratingly common to be overruled by policies and procedures, enacted by non-physicians, that are actually not in the best interest of particular patients.
It's akin to the frog-in-boiling-water phenomenon. I was a health care management consultant before I went to medical school. I didn’t understand why it was difficult to get doctors to come to meetings. I found myself gravitating toward clinical discussions, made the decision to go to medical school, and now understand why it’s difficult to get a lot of doctors to come to administrative meetings. It is because we enjoy being clinicians and we are busy being clinicians. But we had no idea what we were doing to ourselves by abdicating participation in administrative decisions.
Physicians are the compulsive “i-dotters,” “t-crossers,” and obstacle clearers. We’ve spent a lot of years and a lot of money to finally become credentialed in our specialties. Any black marks against us are psychologically disturbing. And that’s where they have us.
I’ve been thinking lately that an unjust system is assisted by the many. Unjust leaders are supported by compliant masses. There were many all too happy to enforce all manner of covid rules over the last two-plus years. The desire to be thought well of by others favors compliance.
I once heard a controversial conservative media personality say that one of the hardest things for him to come to terms with was being hated, despite his conscience being clear of all accusations leveled against him. We all have a choice to bow to the opinions and dictates of others. As this angry doc said, “But they will not leave us alone. No, they will impose requirements onerous and nonsensical on us that we will quietly accept. In doing so, each time we lose a little bit of self respect. The pile gets more burdensome and we stoop a little more as we shuffle down the hospital corridors to our drab clinics and shabby offices.”
We are not just in danger of losing self-respect. We are in danger of doing harm, which is in direct violation of the foundation of our profession. God told us to love Him and love others. It is fear of God that gives us the courage to risk our reputations and it is love of others that calls us to risk our very livelihoods in order to do no harm. The many can perpetuate an unjust system. But the many can also stand against and, just maybe, Lord willing, change an unjust system.
I worked as a medical librarian in a large provincial hospital in Victoria, Australia for 30 years. When I started in the position, the hospital was basically run by the medical staff, assisted by a General Manager whose job was strictly confined to running the physical faciilty, personnel management (later known ominously as 'human resources') and budget. But gradually things changed.
I watched with increasing dismay as the medical staff capitualted, inch by inch, to power-hungry managers, soon to be known as 'Executive Officers'. The corporate world, with its ethos of top-down power, was rapidly encroaching on what had been, essentially, a blissfully democratic institution in which decision-making was made by the real experts.
One day a new 'CEO' arrived from overseas. This person's maiden speech to the hospital staff ended with this threatening pronouncement: "I understand that, hitherto, this organisation has been run by consensus. That ceases from today".
Over the years I pleaded with the medical staff to stand up to the new management. But they were too immersed in their work. One by one, the more vocal medical dissenters were fired on various pretexts. The doctors badly needed to organise and close ranks to retain any control of their hospital. Sadly they did nothing. Gradually, remorselessly, a happy, productive place of healing was turned into a miserable, over-managed medical factory, in which the patients became statistics and the doctors just cogs in the machinery.
This was a great article, a badly needed assessment of the fall of medicine, as it currently stands. And you’re right, I’m not even in the field but I’m one of the observers as a patient and was amazed at the numbers of scared conformists that pose as healers. And the hospitals have indeed sacrificed patient welfare on the alter of protocol/profit. At 70 I’ve previously seen the real article, and what passes for medical assistance these days pales in comparison. Equally depressing is the blind faith of the masses that enables the high tech, low ethics-laden, fast talking frauds that are in charge of this mess.
God bless all of you who still care about the patient, and who persevere.