Friday, June 10, 2011

So Much For Paying Me for Keeping You Healthy

Okay, America. Stay healthy. Eat only two thousand calories per day, exercise five times a week, don't smoke, keep your body mass index at an appropriate level and for goodness sakes, don't let me find your hemoglobin A1C over 6.5, ya hear? I demand it.

Okay, Mr. Hospital-Employer, I did my part, now pay me, okay?

What? You won't? What do you mean when you say I haven't DONE anything?

I have just broadcast to the world (via the internet, no less) exactly what I should be doing to keep people healthy. Isn't this payment-for-keeping-people-healthy thing supposed to be our new payment model going forward? We're all in this together, right? You know, one big happy Accountable Care Organization. Accountable for the quality of care we provide and for our ability to keep people out of our doors. What's better than preventing illness for lowering our costs to the health care system?

What's that you say?

What do you mean I have to work nights and weekends now? I've been your stalwart foot-soldier! I've done everything our administrative directors and the government has asked me to do: click questionnaires, completed my charts, looked at patients in the eye when I care for them, even went above and beyond to blast sincere public service announcements on your behalf!

What's that? They're getting sick anyway?

No way. They can't! They've done everything right! They've followed my every message! People don't just get cancer! We can STOP that, darn it. Maybe we can issue a few more sincere press releases and policy ideas...

Yes, sir. Sorry, sir. I'll try to do better. No problem going to another hospital that you bought. Really. No that's fine. What's a few more RVU's, right? Yes, sir, I understand.

* pause * (Reaching for his cell phone)

"Honey, I'm going to be a bit late tonight. Looks like I have to see a few more consults..."



Anonymous said...

Dr. Wes,

I'm really worried about you. You need to make a resolution that at least one day a week you will write about something that has pleased you at work. This is crazy!

DrWes said...

Anony 09:20-

Thanks for your concern. Fortunately, my patients keep me sane and I find them immensely enjoyable.

It's the developing bureaucracy that needs the work...

Anonymous said...

Dr. Wes,
I feel the same way. The bureaucrats and politicians so willing to tell us how to practice yet unappreciative of the Herculean demands of the profession. Bad news, though. It will only get worse.

Medicine will soon be practiced similar to FAA guidelines. There will be a huge book of regulations to be satisfied prior to any intervention/medication/treatment.

I cherish my patients also but count the days to retirement. The sadness in leaving my patient will be balanced by the relief of abandoning a broken system.

Anonymous said...

Sounds like some shitty nursing job ya got there Wes.

SCRN ;o)

Tim said...

Nurses are usually employed by someone who tells them what duties to perform. Maybe that's why nurses want to be doctors (without much extra training, however).
To the first comment– It is getting ever more difficult to be happy practicing medicine! It's harder to find those satisfying moments. When you save a mother and child doing a 30 second tracheostomy because they can't intubate or ventilate the mother during C-section, that's a happy moment. Realizing that you have the skills and judgment to be decisive and do it is another. Having some bureaucrat, non-practicing physician, or lawyer second guess you on how you did it is only overcome by the smile on that mother's face when she looks at that precious child in her lap! Physicians (at least when I trained) were expected to make judgments and act on them even when the situation wasn't ideal. Now, we are raising a generation of "health care providers" who will have to follow the recipe (guidelines, best practices, etc.) to provide care. Of course, with a good recipe, anyone can do it. Right? Before that blue pregnant girl and her blue unborn child will get some relief, the "provider" will have to nervously get the book out to see what to do. That will take about 5 minutes after they find the book. Brain death in 4 minutes?
When you train people to be decisive and take action when others can't and don't want to, they really take offense at the protests from the wimps on the sidelines or the Monday morning quarterbacks. But don't worry! our generation will be gone before long!
Good luck with your "provider!"