Thursday, May 8, 2008

Physician culture - 25 Things I've Leaned about the Physician Culture

1. People become doctors to serve patients, not hospitals or business corporations.

2. Patients are not “customers,” they’re individuals who need your help, even when that help may be expensive and experimental.

3. Physicians are “the patient’s advocate,” a protector and guide through a world fraught with obstacles to care.

4. Filling outforms frustrates doctors because paperwork takes time away from seeing patients: some doctors take hospital jobs because they can practice medicine rather than processing paper.

5. HMOs increase health costs by over-promising coverage, then restricting it, and requiring doctors to hire three to four employees to monitor it.

6. The basic promise of consumer-driven care is that empowers patients and weakens middlemen.

7. Physicians like consumer-driven care because they believe patients, i.e. health consumers, in control of their own money will tend to be more judicious in selecting their doctors.

8. Regulation has its place, but too much of it stifles innovation.

9. Doctors distrust malpractice lawyers because most suits are trivial, and avoiding these suits requires doctors to practice defensively.

10. The American culture demands the best, accepts nothing less, and rewards lawyers if they do not get it.

11. Diagnosis is a creative act based on experience and cannot always be guided by data.

12. Clinical protocols often fall short because no two patients are the same.

13. You see patients one at a time, and you don't feel responsible for "population health."

14. You are responsible and accountable for patients while they’re in your office and in the hospital, but you can’t control what they do once they’re not under your influence.

15. You realize patients spent 99 percent of their time outside your office, and you know ill health often stems from flawed life styles and rarely rests on your advice, which you are not paid for offering.

16. “Health care,” as administered by health professionals, is responsible for about 10% of a society’s health; the rest is genetics, environment, lifestyle, and cultural socioeconomics.

17. Investor-owned HMOs profit from maximizing marketing and minimizing care.

18. Physicians tend to distrust organizational activities. Your success has always been by dint of your individual effort, whether that effort has been getting good grades in college, doing well in medical school to qualify for the residency of your choice, or caring for sick patients in academic medical centers or inner-city hospitals.

19. Your rewards have come through working hard, mastering your specialty and impressing colleagues, not through participating in hospital, HMO, or corporate bureaucracies.

20. You dislike organizational politics. You detest meetings. You turn a wary eye toward any activity that takes you out of the operating room, off the wards and away from your office, for those locations are where you’re patients, your joy in doing well, and your income are.

21. What has any managed care organization, hospital or business corporation done for you? HMOs, in your mind, manage cost not care. Has any HMO medical director or health executive ever helped you care for a patient better? Has any HMO policy improved quality of care for your patients? Has adherence to clinical guidelines really helped you find the right answers to your patient’s problems? Has any managed care organization placed at your fingertips in the waiting room, at the “point-of-service,” an easy-to-use information system that saves you time by telling you what drug to use, what diagnosis to consider and or whether the patient can pay?

22. Everything that relates to the new competitive environment has discounted your fees, driven down your revenues, compelled you to hire more personnel to deal with HMO clerks or “Doctor Denial” HMO medical directors and forced you into organizations where autonomy is less, rules are stricter, income is lower, work is harder, and a production-line mentality is at work.

23. Doctors are tech-savvy; 99% have computers with broad band access; but at this stage most feel they don’t need EMRs with all the bells and whistles until EMRs become less expensive and more clinical relevant.

24. A computer in the same room situated between the patient and a doctor changes human dynamics between the two.

25. You’re a professional, not a "provider" to be ordered about. What do these health care executives and those on the other end of an 800 line know about practicing medicine anyway?

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