Medicine Unity

Our goal here is to explore different solutions to bringing healthcare back into the hands of the healthcare provider and the patient. Over the past 30 years a lot of “third parties” have become involved and impaired seriously the patient-provider covenant of trust. We want this to be a forum for exploring different ideas and solutions to what you the healthcare provider, i.e. Physician, Nurse Practitioner, Physician Assistant, Nurses etc feel we need to do to bring us closer to our patients. I hope you all find value in this need and participate with your suggestions. There are no right or wrong answers and all feedback is welcomed. Hope to hear from you. Regards, Al

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6 Responses to Medicine Unity

  1. The adequate Treatment for Canada’s failing health system firstly is criminal prosecution and jail for the bad doctors, bad nurses for failing to help the sick people adequately but still having enforced, Real management, supervision of doctors, nurses, medical and hospital workers. It is still a criminal act now for any doctor, nurse, hospital administrators, medical supervisor not to provide medical care to any seniors. How many have been prosecuted for this in the last year?
    http://thenonconformer.wordpress.com/2010/08/03/the-adequate-treatment-for-canadas-failing-health-system/

    • al2decho says:

      Thank you for your comment. I don’t disagree with your concerns regarding the lack of prosecution of “bad” physicians or any healthcare provider for that matter. A huge part of the problem is the deafening silence of the medical profession when it comes to policing our own. Precisely because of our nature of autonomy and lack of cohesion events such as you describe occur. I believe the healthcare world would be a better place if physicians would come together and “manage” our own issues and be left alone to practice medicine. We have allowed governments and other numerous third parties dictate how we practice, how we get compensated, how we get assessed, and how we live. I am sure we have a lot of the same issues you mention here in the US.

    • Rich Donadio says:

      Hi, some interesting comments have been made here. I would like to respond to the comment about physicians refusing to see patients. The way I understand it both physicians and patients have the right to refuse to continue on or enter into a relationship under certain circumstances. Patient’s have this right to a degree depending on what their insurance may be. Patients can choose what physician they would like to see as well and this may be limited by certain insurance programs. I think it is important for patient to continue to be able to have a choice in whom they wish there physician to be. But as the new healthcare plan unfolds I think we’ll see some restriction in this regard. As far as physicians having right not to see a particular patient and to stop providing care; physicians must continue to have this right. This is because under particular circumstances it can be vital to the patient’s well-being and society’s best interest. For example, when talking about narcotic diversion one must understand that if the physician has reason to believe that the patient is diverting narcotics they have an obligations to stop administering narcotics. In fact, the physician also has a right to dismiss the patient. This is a huge problem and I would refer one to the video on Hulu entitled OxyContin express.

      As far as physicians not seeing the patient for insurance reasons, I think it happens all the time and appears to be perfectly legal. Many times we will refer patient to another practice perhaps at a tertiary care center and they will report back to us that they do not take Medicare or Medicaid. And thus will not see the patient. Also some groups will review the records and report back to us that they cannot offer the patient anything will not see them. I think that as long as we have some elements of the free market in medicine we will continue to have different physician groups seeing patients with different payer mixes than other groups.

      I think that if the patient is being seen in an emergency situation and being denied care we are talking about an entirely different matter. I think that there is a moral obligation to stablilize the patient and take care of them as best as can be done with the circumstances as hand and would believe that if a physician refuses to see a patient in this type of setting then perhaps we would be talking about some serious legal consequences. And rightly so.

      What can we do to make it better. I would have to agree with some other comments made here that physicians on the whole need to do a better job with self policing and policy making. Otherwise other agencies will step in and do it for us. And likely not they way that is beneficial to the medical community or society as a whole.

      • al2decho says:

        Hi Rich, Thank you for your input.
        While I am a strong believer in democracy, freedom, and the right of self determination I think that when it comes to providing medical care it is our sacred duty and obligation to use our talents to the best of our ability and provide that care to everyone and anyone that needs it. Working in healthcare is not a job it is a calling. Society must address and fix the issues of the “haves and have not” and it should not be us making the decision to withhold care. Would a priest not help a another because their faith is different. I don’t think so. Insurance Companies are a 20th century creation and add absolutely nothing to help in the care of a sick patient. That being said, not all insurance companies are created equal and some are more socially responsible than others. The individual person must understand that everyone is paying for everything in one way or another. There is a finite amount of resources and how the allocations will be decided is the unsolvable problem of our era. All of the Ethicists and people involved in human rights will have to come together and attempt to decipher the imponderable question: When is enough really enough? We all should share in the “good, the bad, and the ugly” as equally as possible. It is not right for patients living in Carrollton having to come to Rome because Wellcare and Amerigroup don’t have any enrolled orthopedic surgeons locally. It should be a requirement for licensure in our state for all physicians and other caregivers to take care of the indigent, self pay, medicare, medicaid, and all others. First steps involve bringing the physician community to agree on just this simple mandate. No one in the state of GA gets a medical license unless they participate as noted above. You will see very quickly that the real doctors will sign up for it and those who never belonged will exit.
        Rich, I have always thought that I would rather have 4 committed individuals on the basketball floor that I know are working together as a team rather than 5 with one of them distracting the rest of us from our mission and vision which is to take care of patients. All of us can do it little by little. Each department chair in the Harbin Clinic can unite their folks, then we unite the department chairs and pretty soon we will have a unified culture of ownership, trust, and integrity with whomever needs to exit doing so. “The culture of an organization is what personality and character are to an individual.” (Joe Tye) That is the very first step necessary. Hopefully a lot of more people will chime in to this discussion so everyone’s opinion can be heard. As I said earlier there are no right or wrong answers but without communication we will never know the direction or the destination we need to be heading for. Let the dialogue continue. Peace, Al

  2. Matt Mumber MD says:

    Al — there are so many layers of involvement of administration in health care now… and these may have arguably come about as a result of physicians either engaging the business side of medicine badly, or not at all. Physician unity in order to cultivate awareness and community makes good sense to me, and will have an impact on MD wellness, burn out levels and subsequently on improved quality care. Assuming that this kind of physician community can come together first to meet their basic human needs, how then would that same community of physicians succeed in managing the business side of Medicine, where before it failed? Less waste? Better policing of colleagues? Cost control? Guideline standardization? Financial quotas, bundling of payments, elimination of third party payors? How to deal with outliers? How to deal with existing expectations re: high tech, high expense meds, devices, techniques, procedures? MD unions? How to fund prevention and supportive care? Several models are out there, but where, when and how to start?

  3. al2decho says:

    Hi Matt. Thank you for your comments. I believe you summarized very well all of the issues that need to be addressed and you end by asking “where do we start?” Well simply put we start from the beginning: First asking ourselves what motivated us to become physicians in the first place. Secondly looking for the root causes of how we arrived at the place we are at. Thirdly coming together as a “UNIT” and brainstorming all of the possible solutions and then setting out an implementation process starting very small to obtain some early wins and build momentum. The Key Themes are: Accept we have a problem; then unite to leverage our strength, and in this case I actually agree with your concept of accepting into the group those committed to the above principles. I feel that if I was part of a safe community of physicians with a common purpose that we could start the journey and we could engage and enroll followers as we traveled to the implementation phase. Every Physician that joins will only make us stronger. The MDA would be an excellent start. We have to incorporate our diverse opinions to form the ultimate and overall mantra that our autonomy is not lost by adding it to a greater good with each of us bringing a special set of skills. We will have to build the boat as we sail and grow it as the need arises. Let the journey begin. 🙂 AD

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