Thank you for these great suggestions. They’re very pragmatic and necessary.
By: Mia George
Tags: Doctors, Hospital Management, Burnout, Corporate Malfeasance

Thank you for these great suggestions. They’re very pragmatic and necessary.

In the long run, a larger problem — the root of the healthcare problem in the US — needs to be addressed seriously, or at all, because it is being ignored to great detriment to the entire population.

The philosophical stance towards doctors which we have developed as a country in the last 2 decades or so must change. Doctors have been forced to continue to work in the same context of tremendous individual responsibility and individual sacrifice, etc as they shouldered in the age of Marcus Welby. This stance was tolerable — the sacrifices worth it — because doctors got, in return, two things they really care about: autonomy and time with patients. These are two significant items of import to physicians which have been effectively stolen by larger corporations (that is to say, people who might have an MBA but sometimes not even that, or who are doctors no longer interested in being on the frontlines and would rather ‘join ’em if you can’t beat ‘em.)

It should be obvious from a purely psychological point of view that people will not operate, in the long run, with ALL disadvantage and NO advantage. Thus, doctors — who are, as a reminder, human beings made of carbon, etc like all other humans — have been developing high rates of burn-out — in some studies over 80% — and continue to leave the profession at high rates even though the return for doctors is back-loaded: that is, there is more burden early in the career and less later. This is because there is no longer much return to that individual human being, a fact which isn’t being conveyed to medical students. Despite the fact that their professions are front-loaded with debt and unimaginable hours and back-loaded with less of it, doctors are still leaving the profession for jobs that pay less because in the gestalt, these jobs still offer more to that human being (who has now burned out because he/she hasn’t been treated as such). The doctor’s vow is ‘do no harm,’ not ‘feel free to nail me to a cross because my life is less valuable than that of others and therefore not worthy of protection.’

Add to that the absurd — and accepted — behaviors of some patients — constant demands for antibiotics and opiates despite the doctors’ many years of experience! I’ve heard these stories for years from several friends who are retired doctors, two of whom retired approx 15 years early due to these issues — and it is shocking that people with NO education or experience in that area will not only question the doctor with 10+ years of it, but will then DEMAND it as if the doctor is merely a barrier between him and the antibiotics he wants, and it is his right to bully the doctor into giving it to him. Imagine somebody hiring a lawyer and then, after being told how to approach the situation, simply tossing all the advice OF THE EXPERT in the trash and simply demanding whatever he/she wants with the benefit of zero knowledge. This seems to happen with frightening regularity in the medical profession, and it points to a psychology of the nation which is covertly (and sometimes overtly) supported by the larger corporate context.

Corporations are also quite hasty in calling burnout — a result of corporate and collective misery — depression. Depression involves a set of official DSM criteria which persist in all areas of one’s life; burned out people report that, once they are out of the onerous setting, they feel fine. Corporations refuse to take responsibility for the misery their takeover has caused, yet feel no qualms about tossing it into the INDIVIDUAL category of depression, thus shifting their corporate responsibility to that individual doctor. Depression is thought to exist in about 20% of burned out patients. The corporation should be addressing the 80% made miserable by their onerous corporate policies, ‘mission statements’ that include primarily making their Board wealthy, and the VIP suites which protect those executives and Board members from the consequences of their immoral actions. None of this should be acceptable in a democracy because none of it is democratic.

Our society has allowed this by approaching doctors as if they are greedy money-mongers just standing in the way of whatever the patient needs a prescription to get. This has been done to support the onerous growth of massive corporations in which the business person will always have more stated value than the doctor. Large news corporations are also corporations, and those reporters are told exactly what they CAN’T say which will jeopardize the corporation’s power which proves, minute to minute, that it is power they cannot handle.

The problem with this narcissistic stance is that it is severed from reality: the doctor has more intrinsic value because the doctor got the education and did the hard work. The business person doesn’t, because he didn’t. Does he want to come down to the ER and admit a patient when the doctor retires early? Is he interested in intubating an ICU patient when the already-massive shortage of critical care doctors becomes even more critical (so to speak)? No. They couldn’t handle this schedule even if they wanted to. Which they don’t.

It makes no sense to have corporations and MBA’s (or for that matter, doctors moving to admin positions for their own relief) run the show when they have much less knowledge and don’t know how to do the job. This lack of interest in being tethered to reality should be expected to cause problems: those doctors who have to deal with the ACTUAL reality are leaving, and their burnout being proven to be exactly that, and have no relation to depression: their lives get better when they aren’t working as doctors anymore! They leave and their lives improve, even with a lower salary. Obviously, this isn’t tenable in the long run. Hospitals should be led not only by doctors but by all other frontliners — nurses, social workers, MA’s, etc — people who are actively and continually on the front lines. It makes no sense to have people without a clue who are also invested in protecting their wealth as a priority run things; it seems an overt violation of basic ethics.

It is time for corporate hospital leaders to do the right thing and advocate for health care worker leadership even if it means that they get out of the way and apply for other jobs they can actually do. Of course, they can always go to medical school.

That way, they can get a taste of their own medicine.