Just Make Them Happy by Stella Fitzgibbons MD


One of my friends recently told me that a family member had developed a severe pneumonia and been hospitalized for almost a month. I told him that, without knowing which hospital the patient was in or who his doctor was, I already knew that deconditioning was going to be a problem…and more reconditioning that would have seen ten years ago. The reason is hospital administrators and their insistence on something they call “continuous quality improvement”. In administrative terms this does not mean taking care of patients, it means taking care of numbers. And thanks to our federal third-party payers, one of the most rewarding is the hospital’s patient satisfaction rating.

The patient wants more morphine? Overlook her risk of aspiration or hypotension and give her another shot. He wants to stop the enemas before the effluent is clear? Hey, so what if an early colon cancer is missed due to inadequate cleanout–at least the patient will say nice things on his questionnaire. This has to be balanced against other numbers, like average length of stay compared with some office bureaucrat’s estimate of how long that sickle crisis or pneumonia ought to last. But a nurse or doctor who refuses a patient request, however dangerous or unreasonable, is likely to be called in to explain why not to alienate patients or families.

My friend’s relative is getting out of bed more and walking whenever somebody can be found to prop him up–usually a visitor since the hospital is keeping patient-to-nurse ratios as high as it can get away with. We can only hope he complains about not being asked to do anything uncomfortable.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  1 comment for “Just Make Them Happy by Stella Fitzgibbons MD

  1. August 11, 2014 at 9:10 am

    It’s a shame how the language has been perverted to serve goals that are ONLY corrupt and cynical. If one reads the principles of TQM (see Deming) or CQI, there is nothing all that brilliant about the principles of quality.
    In modern management styles – you don’t need to know anything more than how to swing a truncheon! As long as your email address is Corporate, you need only to sneer and despise the Underlings who are so stupid, they cannot do their job without being beaten! [Ernst Röhm School of Management]
    In truth, our management styles in healthcare has become a parody of Deming’s work on quality – and this is why the rest of the US manufacturing sector (civilian) has been collapsing for 30 years. There is not enough prosperity left using the current system to afford decent healthcare; so give them cheap healthcare!
    It is all pretense – the same way that wearing a Brown Shirt meant you were a legitimate voice of the German People, staring down the Common Enemy! The Patient is told that his/her harsh scrutiny of healthcare is the path to reform – but it is again merely a club to seize control of the operations. As long as the problem can be identified as a shady, faceless conspiracy of the Enemy, which must be attacked on every front by the People United – one has the recipe for bureaucratic fascism in yet another flavor.
    Here we go…

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