All Aboard! The Train to a Hot Mess
There was a time when physicians were the leaders in medicine. When others respected our roles and did not resent our sheer presence. When various health care professionals enjoyed working within a cohesive medical team where they exhibited their skills with pride, having no desire to impersonate or conflate their professional roles with others or seek siloed practices. When RNs were admired as the frontline patient advocates that they were–not treated as objects of no value and taken for granted. When the teaching of medical students and residents was viewed as honorable and of the utmost importance, not perceived as a burden or imposition that interfered with the business of medicine. Their learning was prioritized and encouraged, not pushed aside in the interest of maintaining metrics. When patients were recognized as human beings requiring the medical team’s assistance for the very best possible health outcomes, not commodities to be moved in and out like meat in a grocery store.
The transformation of medicine from physician-led to nursing-led is deplorable. But it’s happening, with the full assistance of greedy physician minions and others who have decided the train has already left the station. That this nonsense is the future of medicine and those of us resisting need to get with the program. When did we cease being the conductors of and become willing passengers on the train to catastrophe? Why did we park the streamlined “A” train of success and excellence and hop on the raggedy-a** “F” train of disgrace and mediocrity as passengers? It is and has always been my contention that we conceded our responsibilities for two reasons. Ignorance and fear. Ignorance about the corporatization of medicine and just how disastrous it would be to the humane practice of medicine and fear of advocating for patients because we didn’t want to lose our jobs. That fear has made physicians both impotent and ineffective at not only advocating for patients, but also for ourselves. Many nurses, those who were less committed as patient advocates and RNs, began deserting the bedside in their haste to graduate from online NP degree mills. Eager to perpetuate the corporate vision of a profit-driven future of medicine, these charlatans would subsequently misappropriate physician roles upon receiving their certificates. Some never wasted their time working as RNs as they did not wish to delay their efforts to commandeer the physician role ASAP. The dedicated RNs who remained behind did what they have always done. The best they could with what they had, forgotten in the process.
It incenses me when medical doctors, completely aware that the transmutation occurring in medicine is detrimental to us all, simply state that “that ship has already sailed”. Well, I call bulls**t. Ships can be diverted and this is usually done in the interest of safety. The train and ship analogies represent nothing but an excuse for physicians to do nothing and be nothing. To remain passive and compliant by implying that it is somehow out of our hands to change the course of medicine, though we are the only ones trained in and licensed to practice it.
In 1962, a Mexican farm worker, Cesar Chavez, organized manual laborers, a majority of whom were non-English speaking Mexican migrant farm workers, and formed the National Farm Workers Association(NFWA) which would subsequently become the United Farm Workers(UFW) labor union. These organizations would improve working conditions and wages for agricultural workers. The Montgomery Bus Boycott in Alabama, the initial impetus for the Civil Rights Movement, began in 1955 in response to the arrest of Rosa Parks who refused to yield her seat to a White passenger as was required by law. The boycott lasted a little over one year. Ultimately, the laws enabling racial segregation on Alabama busses were deemed unconstitutional as they violated the 14th amendment. Universal integration of busses in Alabama would soon follow. Here’s my point. Both of these events involved people who had a tremendous amount to lose by challenging the status quo. It did not help that existing laws discriminated against them, making their fight much more difficult. The majority of these Mexican-American laborers and African-American bus passengers did not come from a place of wealth. By protesting, they risked losing their jobs, thereby foisting a significant financial burden on them and their families. But protest they did, because what was at stake was their civil and human rights. Now, explain why a group of highly-educated, mostly financially sound physicians are incapable of similar actions to ensure the public receives the safest care and best health outcomes possible? Because fear is a powerful demotivator.
My dear colleagues, we need to stop behaving as pliant, cowering submissives engaging in a bad, BDSM “Shades of Grey”, master-slave relationship with private-equity backed corporate medicine. It’s abusive, demoralizing, in no one’s best interest and most of all, non-pleasurable. We are the masters of our domain–medicine. No one else. Somewhere along the way we derailed and shifted off-track. It is time to get back on track, take the “A” train out of park mode, clean off the rust, prep the engine and get the f**k back into the conductor’s seat where we belong.
“Thinking will not overcome fear but action will.” -W. Clement Stone
Wonderful commentary. Another boost for retire from practice as soon as possible.
Yeah……. One can say it’s a cop-out but the stress level is so much lower when one
is retired. Especially if coming from a full practice of office, hospital care and taking call.
All of which young practitioners cannot do due to the un-efffing believable administrative
crap that EHR and administration imposes on them.
I am unfortunate to say I’m in the last group of FP’s “who did it all”.
I’m so glad I was able to age out and retire at 64. “Pity the fool that goes into primary care.”
Kurt
Another gem Natalie, bravo.
Natalie, when you put fingers to keyboard, I learn an incredible amount. Thank you for educating us. You are a gem.
Thank you.????
I hate to disagree because I believe the issue is multifactorial. I will point my guns at corporate executives, be they hospital administrators, insurance company CEO’s, Big Pharma. They promote mid-level providers in the hopes (short term of course) of increasing profits. Preauth’s are a case in point…..I write stat on all my radiologic orders and all the med orders clearly state patient will go blind if proper med not provided and patient is welcome to go elsewhere for another opinion. Sometimes I will direct the patient to go through the ER if radiology gives them any flack. That way the ER physician can also do his visual loss workup and feed his coffer.
It is even broader than simply the problem in medicine. Medicine is just more symptomatic than the rest of society. Computers are becoming smarter than people, because people are becoming dumber than computers. At the management pinnacle, the myth is that organization and regulation drives success. Throughout history, that belief inevitably leads to the extinction of the civilization which practices it, as “organization” gives way to “superstition.” We are in the “rapid vertical descent” phase, which is surprisingly painless until later.
Visual workup and feed his coffer?? Or maybe the primary threw up his hands and didn’t finish the workup, or maybe as happens to me almost every shift, the primary gives the patient an out-patient order for the study, but the patient is too stupid or too dramatic to follow instructions. I’ve worked on both sides of the fence, but don’t go dumping on hourly wage ER docs who just had the liability and headache transferred to them. We are on the same team.