I’d be lying if I said parts of this didn’t resonate with me. This week’s A Piece of My Mind in JAMA, by Scott Berman, “Gripers and Whiners“:
Now what I hear over and over is a plaintive whine: “The insurance company won’t … ” “The hospital won’t let me … ” “The drug companies … ” Over and over I hear a passive voice, the physician as victim. I hear a lack of responsibility when physicians talk to patients: “I would like to keep you in the hospital for another day, but the insurance company … ” “The office manager says … ” In one case a hospital emergency department physician told me, “We can’t observe agitated patients overnight anymore. If they seem ‘all right,’ we have to send them right home.”
When, dear colleagues, did we get to be such wimps? We have, as physicians, the toughest, longest, most rigorous training of anyone in the health care food chain, and we act like third-year medical students on our first day of clinical rotations. Yes, medicine is more bureaucratic; yes, there are too many papers to fill out. But we have been trained as leaders, as the most highly competent decision makers. Giving in to bean counters at the expense of patient care is an abrogation of our moral responsibilities.
If we are going to be stressed and unhappy, at least let us take that unhappiness out constructively on those who would give our patients less than optimal care. It may be time for physicians to organize, perhaps even unionize. The goal would not be to line our pockets or demand minimum reimbursements. It would be to set minimum standards of care that we will not bend on. Suppose we were to tell hospitals, or insurance companies, that we will not do business with them if they don’t treat our patients right. I can imagine many of my colleagues snorting with derision at such a concept. It is not, I assure you, radical when taken in the context of other civil rights movements. Martin Luther King Jr famously asserted that health care inequality was the worst form of inequality. Many people have made extraordinary sacrifices for the rights of others. I am not even talking about rights of everyone to have health care (which is, emphatically, a right). I am talking about more mundane but important rights, such as the right of everyone to get the same level of care at every hospital, and the appropriate length of stay regardless of who insures them. I am talking about the rights of physicians to know that if they admit a patient to a hospital, that hospital will staff their units with an adequate number of competent nurses.