A Collaborative Mess

col·lab·o·ra·tion

/kəˌlabəˈrāSH(ə)n/

noun

The action of working with someone to produce or create something.
“he wrote on art and architecture in collaboration with John Betjeman”

1. cooperation
2. alliance
3. partnership
4. participation
5. combination
6. association
7. concert
8. teamwork
9. joint effort
10. working together
11. coopetition

OR

Traitorous cooperation with an enemy.
“he faces charges of collaboration”

1. fraternizing
2. fraternization
3. colluding
4. collusion
5. cooperating
6. cooperation
7. consorting
8. sympathizing
9. sympathy
10. conspiring
11. resistance

**Definition of collaboration from the Oxford Dictionary**

The most overused term of the year…”Collaboration”. How many of us in health care are told that the “new” model of practice today is “collaborative practice”? NEWS FLASH!! The model isn’t new. Never has been. Collaborative practice has existed in medicine for decades and is not a novel concept. As a medical student, I was part of many teams that included the attending physician, residents/interns, nurses, nutritionists/dieticians, pharmacists, NPs/PAs, psychologists, physical/occupational therapists, janitorial services, etc. What was very clear was that the physician led the team. He/she set the tone for the process that would ultimately lead to the best care and medical management for the patient. It was exciting to witness each member of the team functioning expertly within their own discipline. The team unified in their mission and each role clearly defined…no blurring of the lines. No confusion. This model worked well–for years. American medicine was number one in the world during that period. It worked because the art of medicine was respected as a discipline. Not today.

Many of us can recall when chest x-rays were ordered to VERIFY one’s diagnosis of pneumonia, not MAKE the diagnosis. Egophany, magnified breath sounds, etc., all confirming consolidation on auscultation. We knew where the pneumonia was most likely located because of our detailed physical exam. We used our senses of sight, smell, touch and hearing to evaluate our patients and subsequently created a differential diagnosis. We would consult our colleagues in various specialties to assist us with the more complex patients. COLLABORATION. We would discuss a patient’s diet with the dietician/nutritionist so as not to exacerbate any previous existing co-morbidity. COLLABORATION. RNs, experts in their own right, would keep a pharmacopoeia in the nurses station, double and triple checking medication orders and dosages, questioning physicians for clarification when necessary. At times, identifying mistakes that may have been missed by the physician or pharmacist. Informing the physician so the error could be addressed and corrected. COLLABORATION. Respiratory therapists providing nebulizer treatments while adjusting the percentage of oxygen in patients with COPD or emphysema who were admitted for pneumonia, with the physician’s knowledge and approval. They knew their stuff. COLLABORATION. You see, there was always collaboration, even within the physician-led team. There was a mutual respect for each health professional’s role while still respecting that the buck stopped with the physician. That was physician-led medicine.

The business of medicine has taken what was a 5-star restaurant and created a fast food joint. Popcorn medicine. Wal Mart, CVS, etc. minute clinics. Metrics–forced algorithmic medicine, no longer the art it used to be. “Collaboration” is more consistent with  “collusion”, meant to diminish the physician’s role not only as the leader of the team, but as a member of the team, period. It is more evident, in my opinion, that our licenses are what corporations need(for liability purposes), not us. The goal of any business is to make a profit. The commodities in medicine are the patients. The more patients, the more financial rewards one can expect. Volume-based medicine, not value-based medicine, is the goal. To make a profit, one has to diminish expenditures. Welp, physicians just cost too damn much. Wiser to use a cheaper version of medicine for the commodities and save money all around. Using the cheaper versions who will inevitably use more resources(to counter what is missing in medical knowledge) which, in turn, brings more money into the business. No more art of medicine. No more practice of medicine using deduction and critical thinking. Move ‘em in, move ‘em out…like cattle. Think of the movie “Hud”. The cattle(patients) being led to slaughter in a ditch. Because it isn’t about health care, it’s about the illusion of care while creating a financial bonanza. The loss of a few commodities(patients) is an acceptable consequence of doing business.

Call it what it is. Collusion. “Traitorous cooperation with an enemy.” Enemy being any corporate structure that places its financial bottom line above the care of the patient. There is  and will be no collaboration when medical “teams” consist of disciplines that are siloed, communication is disjointed or absent, care is uncoordinated, mutual respect is lacking, vitriol against physicians is ignored or encouraged and a medical leader is non-existent. Which is exactly what we have today. Any wonder why America is #47 in health care outcomes? The price of doing business….

It’s sick. Pardon the pun.

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