Do the right thing, but …

Modern Healthcare - - Opinions Letters -

With physi­cians, es­pe­cially aca­demic fac­ulty, pressed at ev­ery cor­ner for time be­cause of in­creas­ing de­mands and de­clin­ing re­im­burse­ment, pa­tient-safety ad­vo­cates must fig­ure out ways to pro­vide the time/fi­nan­cial in­cen­tives to make this hap­pen. That is not be­ing cyn­i­cal or mer­ce­nary; that sim­ply re­flects the de­clin­ing eco­nomics for ev­ery player in the provider chain th­ese days (“Text­book re­vi­sion,” March 15, p. 14).

Physi­cians/hos­pi­tals will only take this se­ri­ously when it af­fects rev­enue ei­ther neg­a­tively or pos­i­tively, and not a minute ear­lier.

A pa­tient-safety fo­cus will have to sup­plant an ex­tant “pri­or­ity” un­less there is more rev­enue di­rected to­ward this arena. We op­er­ate in a zero-sum game in medicine th­ese days; there is no ex­cess ca­pac­ity, slack, etc. (And the tort sys­tem is woe­fully in­ad­e­quate). The As­so­ci­a­tion of Amer­i­can Med­i­cal Colleges/Joint Com­mis­sion sim­ply can’t layer more ex­pec­ta­tions onto an in­creas­ingly un­der­funded health­care and med­i­cal-train­ing sys­tem be­ing asked to per­pet­u­ally do more with less (and cap­i­tal­ize ma­jor health in­for­ma­tion tech­nol­ogy ex­penses cur­rently).

Physi­cians/fac­ulty want to do the right thing, but they no longer have the time and en­ergy to do all the right things that so­ci­ety is ex­pect­ing of them. Some­thing has to give, and as we see, its pa­tient safety in this case.

For those who no longer see pa­tients on a daily ba­sis for their liveli­hood to ex­hort for pa­tient safety from bully pul­pits in­vites en­nui and cyn­i­cism even among the most ide­al­is­tic of clin­i­cians. You must find the dol­lars, you must make hard choices, and you must sup­plant other ex­tant pri­or­i­ties. To el­e­vate pa­tient safety in an era of de­clin­ing bud­gets, what will you sac­ri­fice?

And please don’t dis­miss this rhetor­i­cally by la­bel­ing this line of rea­son­ing as false or a Hob­son’s choice un­til you re­turn to work­ing 60 hours a week see­ing pa­tients on a pro­duc­tion-line prac­tice or are will­ing to meet me in the op­er­at­ing room at 6 a.m. to dis­cuss your ideas.

Every­one wants more pa­tient safety. Who wouldn’t? The ques­tion is how will we pay for it, and what will we re-pri­or­i­tize to give it the

at­ten­tion it needs? Be spe­cific about what you would do in­stead of ad­vo­cat­ing “pa­tient safety” in a ster­ile aca­demic vacuum.

Med­i­cal stu­dents all start out rea­son­ably com­pas­sion­ate and con­cerned about pa­tient safety. It’s the sys­tem of prac­tice that grinds them down/dis­tracts them. This is not a teach­ing or role-model is­sue. Fun­da­men­tally, it’s like all things in medicine: a time and money ma­trix. How do we solve that in this era? J.D. White

Physi­cian Wash­ing­ton

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.