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Tuesday, December 18, 2012

I was just thinking about medicine... dangerous!

The climate of medicine is definitely changing, and not for the better. Just today, our small group of hospitalists (those who just take care of patients in hospitals), met with our CEO, to discuss ways to bring down our lengths of stay for patients in our hospital. Now this discussion came about because our hospital, in November, lost money - the total for the hospital was over 1 million dollars in the red. Now,  I do not pretend to understand all the whys and wherefores of how this came about, but I will tell you that medicare payments to hospitals look like they will take a major nosedive (to the tune of 25%) in 2013. That is enough to make any hospital CEO have indigestion, angina or worse.

And so, why am I writing this?

It is because I really used to love this avocation. I truly loved taking care of sick patients - those who needed my expertise, who looked to me for answers, and for help. But it is hard to love a job in which your working long hours, taking care that your very ill patients are properly cared for, is summarized on a sheet of paper in which your length of stay, your case-mix index, and your standing compared to "the national average" means so much more than your skills and compassion.

Now, when I got out of training, I was really ready to do whatever needed to be done, to go that extra mile, for my patients. And I was looked up to, was sought after, and was highly regarded for my efforts. These efforts have not changed, however, their significance has been trivialized, to the point where I have been considering that this might just not be worth it after all.

How and why have we gone so far off that formerly sacred path; you know the one with the doctor and the patient being the important ones in this mix? It is economics, purely and simply economics. It has to do with the invention of the DRG (Diagnosis Related Group), and with the influx of the overseers who have come to recoup the revenues that were considered wasteful.

This was made even more poignant when I was listening to a discussion about the current state of medicine, and one of my colleagues said that a prominent cardiovascular surgeon became discouraged, when he found out that it would cost more to have his dog operated upon, than he would get from doing a heart transplant! Yes, that's right.

So, do I plan to put up with this nit-picking, mind-bending and basically made-up trivia? Well, for the present time, yes. Though I tell you, it takes the joy out of this season of joy to read that your length of stay, factored in with your case-mix-index just doesn't seem to be measuring up to standards.

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