This post should be required reading for every physician in this country. A physician finds a document on a chair in his hospital executive’s waiting room and reads through it, then realizes it is a manifesto on how to dis-empower physicians and put hospital administrators in control of patient care. The document’s title: How to Discourage A Doctor
While the physician implies that he transcribed the information from memory, the formatting breaks and text errors in the document make it appear as if the document was scanned and then the text pasted. “Transform physicians from decision makers to decision implementers. Convince them that their professional judgment regarding particular patients no longer constitutes a reliable compass. Hiring, firing, promotion, and all rewards should be based on conformity to hospital-mandated policies and procedures”
“Increase physicians’ responsibility while decreasing their authority. For example, hold physicians responsible for patient satisfaction scores, but ensure that such scores are influenced by a variety of factors over which physicians have little or no control, such as information technology, hospitality of staff members, and parking. The goal of such measures is to induce a state that psychologists refer to as “learned helplessness”. “Above all, introduce barriers between physicians and their patients. The more directly physicians and patients feel connected to one another, the greater the threat to the hospital’s control.”
Whether the entire back story of the article is true or more of a parable, the concepts described are being implemented … and they are a serious threat to the health care in this country.Look at some recent medical research.
This survey showed that hospital ownership of private physician practices has increased dramatically in the past 6 years. In 2008, 62% of physicians owned private practices. This year, only 35% of physicians maintain independent private practices. Only 9% of physicians “mostly agreed” that hospital employment of physicians would increase quality of care and decrease costs. 81% of physicians described themselves as “overextended” or at full capacity.
This survey showed that government regulations regarding electronic medical records are being implemented but that 75% of physicians believe that the electronic medical records increase costs and do not save time. 68% of physicians do not believe that the regulations improve productivity and 48% do not belive that the regulations support coordination of medical care.
This study showed that time lost in dealing with electronic medical records was “large and pervasive”, costing physicians an average of 48 extra minutes a day – during which they could have been performing other tasks such as patient care.
I’m sure that hospitals, their administrators, and their attorneys will all deny that they are trying to discourage physicians or to drive a wedge between physicians and their patients. Draw your own conclusions.
However, as more physicians move to hospital based practices and exhibit less autonomy, think about who stands to gain and who stands to lose from such transitions.
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