Sunday, December 13, 2009

Overheard At The Wash Bowl

A few weeks ago, I decided to cut my very long, very ... scraggly hair. It was more of a therapeutic experience than really caring about my hair length. After discussing what I wanted done, the woman I go to started asking about my pre-med path, how it is going (haha - or not), what she could do to help (pray!), and then led me to the wash basins.

This particular spa puts lavender heated wraps around the neck area so while being soaped and head massaged, the aromatic therapy unwinds the mind. I LOVE it. She is amazing at it too :)

Anyway, we started talking about finances related to school, my favorite classes (physics and biochem - gen chem can kiss my ...) when the lady next to me piped in asking what schooling I was going for. Telling her med school, she asked if I was nuts (yes, probably).

She then went on to disparage the hospitals, clinics, medical professional partners and finally stated that she wished she had more business background when she entered the profession.

She is an MD and an unhappy one at that.

I feel for her. She said she loved her patients, loved the care providing, and science aspect of the job but hated, simply HATED, the business aspect of it.

Several months ago I was telling my then boyfriend, a physician, what I think went wrong with the medical industry some decades ago. So, I'm going to digress here for a minute, or two.

Back in the 1800s a doc with a dark black bag, a stethoscope and some quinine pills set off on his horse, or maybe with a buggy, and visited his patients. He listened to their stories, he took their lives into consideration when thinking about how to help, and then hopped back into his buggy and went a few miles down the road to his next patient. When patients were too sick to pay at that time, he probably figured out another way they could "pay" their bill, and moved on.

In his community he was beloved by all. As time moved forward and his patient practice grew, he recruited another doc knowing he could not provide the best care for his growing practice and awesome reputation. Some time after that, the doctors needed a nurse to help with triage and opened a small, tiny clinic in the town. As that practice continued to grow, the docs hired a bookkeeper to help pay the bills, pay the nurse, and of course, pay themselves.

Eventually, that one doc shop turned into a large clinic by the early 1900s, several small clinics merged to become a larger clinic and no longer hiring just bookkeepers, they hired finance people to run the business aspect.

The business people probably had no medical experience but saw with a twinkle in their eyes how much money they could make providing guidance and strategy to physicians. As that larger clinic grew, just a finance person was not good enough and an MBA had to be hired.

Now that small doc with a horse and a buggy had lost control over HOW he managed his patient's care, WHEN he managed their care, and HOW LONG he could spend with each one.

On top of that, business people are not known for their empathetic nature only looking at bottom lines and financial statements. CEOs of large behemoth hospital/clinic/pharmacy chains are generally not physician trained.

Therein, lies a HUGE problem. Empathy gone at the top (in the business world we call that "tone at the top" for Sarbanes-Oxley purposes), moral compass and doing what is right somewhat skewed by bottom line numbers, physicians are caught in the middle of a web of MBA branded CEOs and presidents, vs. CEOs that are MD trained.

I bet the woman at the wash bowl was in a clinic setting run by a CEO with an MBA, a 7-figure salary, and the inverse amount of empathy. I can understand why she doesn't like it. The politics of becoming a sycophant so that required operating conditions are set is not fun in any setting.

In this case, people's lives ARE at stake so the stress has to be greater.

When she heard my background, she proclaimed, "You'll be fine being a physician. You already know the dirty politics of the business aspect of it."

Sadly, I do. Too bad as a society we have lost our direction and course of what it means to provide and receive medical care and is now a business; just like a bank, or auto dealership, or Target.

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