Doc­u­men­tar­i­ans take a hard look at hos­pi­tals

Modern Healthcare - - Outliers -

Once upon a time, hos­pi­tals were the good guys.

They mended bro­ken bones, took care of the in­jured with­out first ask­ing about in­surance cards, and oc­ca­sion­ally per­formed med­i­cal mir­a­cles to re­new our faith in heal­ers.

Those days of hos­pi­tals por­trayed as do-good­ers, how­ever, are gone—at least, if in­de­pen­dent films are any barom­e­ter.

Out­liers has noted a pro­fu­sion of in­de­pen­dent films about hos­pi­tals in re­cent years, and we set out to sam­ple a few and see how the wind is blow­ing. And let us re­port: it’s enough to make one want to con­vert to Chris­tian Sci­ence.

Read­ers of this mag­a­zine will note some dis­so­nance be­tween the sunny in­sti­tu­tions por­trayed in their in­house hos­pi­tal PR lit­er­a­ture and the avarice, greed and care­less medicine por­trayed in these films. But whether that dif­fer­ence owes to a blind­ness to pub­lic per­cep­tions within the hos­pi­tals, or to bi­ases of the film­mak­ers, we’ll let the view­ers sort out that ques­tion on their own.

‘Do No Harm’

Di­rec­tor: Re­becca Schan­berg; run time: 55 min­utes Of the three films re­viewed here, “Do No Harm” hews most closely to the tra­di­tional no­tion of doc­u­men­tary film­mak­ing. It tells the story of two whis­tle-blow­ers, ac­coun­tant Charles Re­hberg and sur­geon John Bag­nato, whose bat­tles with their lo­cal hos­pi­tal, Phoebe Put­ney Me­mo­rial Hos­pi­tal, in Al­bany, Ga., have been well-doc­u­mented in this mag­a­zine and else­where.

Re­hberg and Bag­nato level dev­as­tat­ing claims against their com­mu­nity hos­pi­tal, us­ing in­ves­tiga­tive re­port­ing tech­niques to show, among other things, how board mem­bers were jet-set­ting at the Ritz-Carl­ton in the Cay­man Is­lands us­ing the hos­pi­tals’ off­shore in­surance cap­tive, while the hos­pi­tal gar­nished the wages of lo­cal unin­sured res­i­dents who couldn’t pay their in­flated med­i­cal bills.

“We kind of de­scribed it as a re­verse En­ron,” Re­hberg says in one scene. “Where the pub­lic com­pa­nies are con­stantly try­ing to fi­na­gle their fi­nan­cials to boost their ap­par­ent prof­its, the non­prof­its ac­tu­ally have the other dilemma. They need to pub­licly look like they have less. It helps them when they go to the leg­is­la­ture, to look some­what poor. And it helps them with their PR a lot to not look like they’re real wealthy. So they tend to look for places to put cash. The Cay­man Is­lands is one of them.”

The film’s biggest weak­ness is its com­plete lack of per­spec­tive from the hos­pi­tal. While the Phoebe hos­pi­tal ex­ecs surely didn’t line up for in­ter­views, they filed hun­dreds of le­gal records over the years lay­ing out their side of the story, which could have been mined for in­for­ma­tion.

‘The Van­ish­ing Oath’

Di­rec­tor: Ryan Flesher; run time: 74 mins. It’s im­pos­si­ble to re­view this film about sys­temic physi­cian burnout with­out be­gin­ning with its most glar­ing short­com­ing—the di­rec­tor and main char­ac­ter, physi­cian Ryan Flesher, comes off as in­suf­fer­ably whiny.

Out­liers nearly couldn’t get past the first 10 min­utes of the film, as Flesher’s self-in­dul­gence in mak­ing a film about his own hope­less­ness de­volves into the kind of self-pity that is the death knell of any au­to­bi­o­graph­i­cal story: “Ba­si­cally, I’m a mis­er­able wreck, and I’m never at ease,” he says early on.

The movie finds its foot­ing in the can­did in­ter­views with five other physi­cians from across the coun­try. They all look like de­cent peo­ple who any­one would love to have as their doc­tor, and yet these physi­cians de­scribe the same burnout, dis­af­fec­tion and loss of ideals as Flesher as they talk frankly about how pro­foundly eco­nom­ics drives the health­care sys­tem. Fourth-year med­i­cal stu­dent Sarah Sch­mick­rath’s voice qua­vers as she talks about how her hopes crashed into the re­al­i­ties of mod­ern medicine: “One of the rea­sons I went into medicine is be­cause I re­ally, truly did want to help peo­ple. And what I’m com­ing to re­al­ize, and why I was so dis­il­lu­sioned and still am sort of dis­il­lu­sioned, is that … the sys­tem is set up in such a way that that’s al­most im­pos­si­ble. Even if you re­ally care and you re­ally want to help peo­ple, it’s ex­tremely hard to do that in this sys­tem.”

It makes Out­liers wish some­one else would have di­rected the movie, and just used Flesher as an anec­dote.

‘Lewis Black­man’

Pro­duced by Trans­par­ent Health; run time: 50 mins. “Lewis Black­man” (full ti­tle: ‘ The Faces of Med­i­cal Er­ror … From Tears to Trans­parency: The Lewis Black­man Story”) is the most likely of the films re­viewed here ever to be played in­side a hos­pi­tal, and that was the mak­ers’ in­tent: Trans­par­ent Health as­sem­bled the movie (the first in a se­ries) with the ex­plicit goal of ed­u­cat­ing care­givers about pre­vent­ing med­i­cal er­rors.

The film is the most clin­i­cal of the three, but this strangely an­ti­sep­tic feel works to in­crease emo­tional im­pact in some sec­tions. Black­man’s mother, Helen Haskell, de­scribes in even tones her har­row­ing ex­pe­ri­ence in which her son went in for an elec­tive surgery and bled to death in the hos­pi­tal af­ter a week­end crew failed to no­tice his wors­en­ing con­di­tion.

There’s a lot of blame to go around, but “Lewis Black­man” works to dis­arm the re­flex­ive de­fen­sive­ness of clin­i­cians and ad­min­is­tra­tors and make room for some gen­uine soul-search­ing.

“No one was in charge,” Haskell says. “No one seemed to be pur­su­ing goal-ori­ented be­hav­ior. They were just per­form­ing task. They were not try­ing to achieve an end; they were not try­ing to put it to­gether. This was sim­ply a sys­tem that was op­er­at­ing for its own ben­e­fit. The pa­tients were re­ally in­ci­den­tal.”

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