Locked Out

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I had a meeting with some suits a few days ago. Pretty boys from corporate with their perfectly coifed hair and shiny shoes. 

Never trust a man with perfectly coifed hair and shiny shoes, particularly if they are traveling in groups…

I listened to an hour long presentation about how I need to refer within the system more often. How I need to change diagnosis codes to make my patients look sicker. How they will be providing me with more data about how I am doing with preventive care and blood pressure and diabetes and congestive heart failure for certain insurance payers. 

Look, I don’t even look at the crap you are already sending me and I am performing at the top the system. Save yourself the trouble. I am not going to treat one patient differently than all the rest just because they have a different health insurance.

Then I was told that I have to earn a certain number of “points” by logging into their website once a month, attending pod meetings, reading articles that they determine and answering quizzes so I can prove that I am “engaged” and make “bonuses”.

Why do I get so angry? Why do I let it get to me?

When I am around my family, I am hypersensitive. I am just waiting for someone to do something offensive. And if they do not do anything offensive, I am offended. I WANT to be angry at them, damn it!

I WANT to be angry with the suits. It makes me scowl during their presentations. It makes me open my mouth and say things that they scribble in their notebooks and will take back to corporate so I can be put on a list of those who are not “on board”, marked if you will. 

We need to get rid of her…

Words I used with them: dishonest, unethical, etc. I told them it was shameful to treat employees the way they are, limiting the referral base so much that I cannot get them into a psychiatrist for crying out loud. And they are recruiting more companies to particate in this restricted insurance plan. I told them that my primary responsibility was to the patient, not to the system, that I will not refer to a specialist simply because they were part of the system.

Why can’t I just keep my mouth shut?!??!?

Why?

Jealousy: They are making so much money with just an MBA to sit at a desk with no liability. 

Defensiveness: They are telling me what to do. Who are YOU to tell me how to do my job?

Survival: Every time someone up there comes up with a brilliant new idea, they do not realize or care how much more difficult they are making my job.

Moral Superiority: Monopolies make me uneasy. This is what they want. A monopoly. They are selecting for sheep. Automatons who no longer question, no longer think. Follow a protocol. Do as you’re told. 

My mouth, though, this anger and my subsequent inability to play the game… I am afraid it is going to keep me from ever affecting change.  It makes me want to skip these meetings, avoiding them all completely. It makes me want to disengage.

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126 thoughts on “Locked Out

  1. All of the crap you noted would make me want to say goodbye to medicine, or at least go practice in my own small office in a community where folks truly need want I can give to them without corporate medicine directing my every action and the patients getting angry with me when I have no control. I can truthfully say that I would never recommend to a family member that they go into medicine today. It has become something I don’t like very much and the good, honest, caring physicians such as yourself are getting screwed more and more.
    I will stop ranting now.

    Liked by 3 people

  2. God bless you for your integrity. It is so sad when money scores over healing.
    It brought to mind a similar situation with my daughter in China but in that case with education. She felt increasingly cornered into doing things she felt were unethical. Her husband (an ex director and current life coach) encouraged her to start her own tiny school. She did, though it was a great gamble at the time. Her reputation spread like wild fire as being someone trust worthy. She now has 4 schools, a thriving business, and clear conscience. I pray there may be a way your story can have a similarly happy ending somehow. Caring doctors should be applauded, and appreciated not black listed!

    Liked by 3 people

  3. Guess our previous GP surgery belonged to the same company……. fobbing us off with medication we didn’t need for ailments we didn’t have, then charging for every item even though a combination of three made one dose, refusing to grant more than one month’s supply at a time so that they had to write more prescriptions (for which they get paid more money), hospital appointments and referrals for hip problems that didn’t exist. Need I go on?
    Stick to your guns. Doctors who see their patients as individuals with problems and not a number on a tick list are few and far between. You’ve got my vote!
    (note: our new surgery is run by real people, not multi-national cardboard cutouts playing at medicine)

    Liked by 2 people

  4. I hate, hate working for a corporate hospital system. The things I see and hear make me sick. I’m so glad you have this blog! I love hearing from a physicians point of view and I always know it’s not just me making a big deal out of nothing. 😉

    Liked by 3 people

  5. Maybe you can’t affect change here. Not every situation or organization is capable of being saved from itself and this one is clearly on that path. It seems you’re more conflicted ethically more than anything. Reading this makes me angry and I’m detached from the situation until I’m in that situation one day. Maybe it’s just time to move on. I know…easier said than done. But sometimes it’s just time, for your well being and that of your family.

    Liked by 2 people

      • A few days ago, I found myself regretting–deeply–the lack of stability in my current situation. Just as quickly, I had this “aha” moment where it hit me that another way of looking at this lack of stability is limitless potential. I felt so free in that moment.

        Growing up poor, having to pay the bills, the unknown can feel so fearful to me. But then … there’s so much out there, and so much of it that’s beautiful, as long as I remind myself to try seeing a situation as I might if I didn’t feel that gnawing fear.

        This all reminded me of the conclusion to an old post. Different subject matter, some overarching similarities:
        But the truth is, it’s only by leaving an abusive, violent situation that a person–usually a woman–will be better able to take her life to the natural end of its years, and to explore all the good that might yet be, if she can even haltingly accept that the certainty of abuse is not better than uncertainty that includes limitless hopeful possibilities.

        I believe your care, thought and dedication is leading you (and your patients) somewhere better. I wish it could be right now, but I believe all these words and thoughts you’re expressing are helping move you closer to finding–or creating–it.

        Liked by 1 person

  6. Phew, you really dislike MBA’s eh? The diploma that hangs on my wall says quite clearly under MBA “with all the rights, privileges and responsibilities…” And responsibilities are taken seriously – more MBA’s go to jail yearly than any other profession. In business law it was explained very carefully that although we could not be charged for an error if we showed clearly that we were doing our best – that any mistake that we make when we should have known better or if we were deliberately twisting data, is prosecutable. And prosecute they do. My partner who sat next to me in class is now sitting in a penitentiary for exactly that. Don’t underestimate the liability in decision making for an MBA.

    That being said, it is the pursuit of wealth that is the agenda that drives too many decisions – that pursuit creates evil situations – and I don’t use that word lightly. When i was trucking our insurance company came to visit us at a general meeting (it was company held insurance that we paid into through a wage deduction plan). We were having too many roll overs and “left road to avoid..[insert object here].” incidents. Our insurance providers told us this had to stop. They said, in an open meeting, that we were to hit any vehicles that were on our side of the road or that were breaking the law.It was immaterial if lives were lost, what was important was that our policy was to be profitable for them OR they would drop us and we would be unable to get insurance elsewhere. That would put us all out of business. So we were given the choice of killing and maiming people or being bankrupted. Some choice. And so one day,it came to pass that I met a car on my side of the road – head on – and having thought this through over time and made the decision.beforehand as i was instructed, I just braked and went to the shoulder and did not leave the road. The other driver died but my insurance company got paid from his insurance company and I was given a pat on the back – for killing a man.

    I can empathize Victo.

    Liked by 3 people

    • It seems so often from where I sit that the bean counters behave with impunity. So I appreciate hearing that is not really the case. We should not have to make these kinds of decisions, killing vs. swerving.

      Liked by 1 person

      • No, we should not – the problem crept in when we started monetizing everything. I spent some time in Houston some years ago. I had business in Channel view, an eastern suburb of Houston. The road I had to drive down was not heavily traveled and had a railroad crossing -a high speed main line connecting Houston to all cities in the East.Approaching this rail from the south presented one with a 10 foot hedge that blocked all view until the vehicle was on the tracks. One day I was crossing with a tractor-trailer and a train came along – it was touch and go whether I could clear the tracks before being hit. I was upset and the following day just happened on a Safety booth set up in a local mall by the very same railroad that owned the track.. I went on the attack and the poor guy in the booth was taken aback. I insisted that either the hedge had to be moved or a set of lights and crossing guards had to be installed. His response? “We are only required to install warning devices after there is either $10 million dollars damage or a life lost.” And the hedge? “Sorry private property – we don’t control that.” They KNOW someone will be killed eventually but will not install safety equipment until there is because of the money. It makes me want to barf..

        Liked by 3 people

  7. I feel your frustration, anger, and sense of helplessness – see it over and over in the MDs I am in contact with. Bless you for hanging in there – perhaps if there are enough doctors that feel the same way, you can revolt. After all, YOU are the ones treating the patients, not the suits. And I sense it will take a revolt.

    Liked by 3 people

  8. Thank you Victo, for taking a stand for us. The more you do the easier it will be for others to take a similar stand against these bozos. You do hold the power and they know it. That is why they try to intimidate with the fancy suit, polished shoes and snazzy hair.
    Leslie

    Liked by 2 people

  9. This sounds like a dystopian nightmare. The tail is wagging the dog and is creating an atmosphere of disconnect that is pitting one group of employees against another. And this is really stupid because one of those groups is vital. You know ’cause they’re the physicians. Horrible management style. What the suits should be doing is asking the doctors “What can we do to make your jobs easier?”

    Liked by 2 people

    • Like most large organizations, corporate health care is an entity with two interfaces. Upstream, the interface is with the investors, and the upstream side of the business manages the business as a whole while oriented toward their interface (their interface does not include patients). The downstream side of the business does patient care and their interface is with patients. The two pieces of the business have different cultures, different drivers, and different value systems. In short, there is little common ground.

      So, the suits are not going to ask “What can we do to make your jobs easier?” That isn’t something they would ever think of or care about. And, since making the provider’s jobs easier would negatively effect the bottom line, that question will never come up. In fact, if they could eliminate the providers and the fixed plant, both of which are very expensive, the bottom line would look much better. Telemedicine, here we come.

      Liked by 3 people

      • The whole point of the corporate medical structure is to increase revenue and reduce costs so that returns to the investors can be maximized. That’s why the pressure on providers to; refer within the system; use diagnostic codes that make the patient sound sicker; order more tests and more expensive tests; and other similar practices. Sicker diagnostic codes mean more revenue. Referrals within the system and more tests uses the fixed plant better. Referrals within the system mean revenue going to the system instead of to other providers. …

        Liked by 2 people

      • Yep, Dave, you are bang smack on -in the short term. In the long term however, that is a losing recipe. Ultimately, the source of revenue and profit is the end user -and eventually that end user will flee from any organization that cannot service them effectively. It has happened many times – for instance General Motors. The quality and price of their vehicles were becoming problematic some years ago. And to the shareholders, they were Gods because the profits kept increasing. And this was so because of their financing arm – GMAC. GM always reported consolidated income that included the finances and as the financial arm increased in profitability so did the car mfg arm show a decrease in profitability. Thus was akin to a financially incestuous relationship – making poorer and poorer vehicles for inflated costs with a lower volume every year was showing as an increase in profitability. The manufacturing side was dying and the financial was feeding off it it. Anyone with any common sense could see that this was behaviour that converged in eventual bankruptcy – and so it came to pass.

        That said, the medical and insurance companies who are perpetrating the separation of long term shareholder value from customer value are kidding themselves. i’m not always enamored of capitalism (it is the best yet but needs a lot more control than we are exerting) – but it has shown over and over and over that when there is a disconnect between the owners’ best interests and the customers best interests, the organization either has to change or fail. And they are never too big too fail. When the users demanded PCs and IBM tried to focus on Main Frames – IBM almost went into bankruptcy. One if the largest, most secure, blue chip organizations in the world. They pulled it out at the last minute by changing their focus. No organization is big enough to change that reality in capitalism.

        Anyway, the bottomline is that their behavior in neglecting patients is not sustainable. It may take a while but it will stop.

        Liked by 3 people

  10. This is a red-button issue for me. MBAs are the whole reason (ok ONE reason) medical care in the US is off the chart and way above every other developed nation on the planet. It makes me sooooooo mad. As a patient. As a taxpayer. And as a fake medical professional.

    Liked by 2 people

  11. OMG… it is everywhere. I am exhausted trying to work within a broken system. I cannot make the same impact that you can, but there are many of out there that are really trying. Today, much like you, I feel it is futile. The first thing I did when I got home was look at the job boards….but running is not going to solve anything.
    But if anything, you do matter. What you say does count and your patients will always come first. Those jerks with their unethical practices are why the DOH and other government agencies are coming down so hard on everything. We have ANOTHER survey going on right now…. AGAIN…. that is four in one year.
    I could write a book on all this crap we call health care, but I am going to take my aggravation out with the lawn mower and be grateful tomorrow is Friday.
    Sending you a big hug and reminding you that you make good bucks…. and it is not forever….go make cupcakes with your sweet children.

    Liked by 2 people

  12. I am definitely not a fan of your health system! I follow a blogger who waited a long time before getting very serious health issues checked out due to financial worries and no insurance.
    I hope we continue to treat everyone here regardless of insurance. We are definitely not a perfect system, but I do think we are more ‘human’.

    Liked by 1 person

  13. My doctor gave notice of his retirement, he is 61. I’m not really surprised. When his office became part of a hospital network affiliate, they removed his name from the sign in front of his office of 35 years. A sign of the times ? sad

    Liked by 2 people

  14. I meant to write a post about why I decided to leave practice and join the corporate world. I don’t think I’ll need to, anymore. When the questions change from, “How many patients were successfully treated?” to “How much revenue did you generate?”, I think it’s time to move on.

    Liked by 1 person

  15. I agree with DM. Thank goodness there are physicians like you who don’t go along meekly with crap like that.

    I’ll share a story. My neighbor grew up in a poor farming family. The children were born at home because they couldn’t afford a doctor (even though they were much less expensive than they are now). But his mother was having a difficult time delivering his sister, so his father went and got the doctor. The doctor delivered the child and may have saved the mother’s life. Later he sent his bill (I forget the amount, but I think it was $15). At the end of that year the farmer (a fine man, who I knew when I was a boy) sold his crop and after paying the crop lien (for fertilizer, seed, etc.) he had netted about $15 for the year. So he went to the doctor and told him, “I mean to pay what I owe you and I have it with me. But my mule died and unless I buy another one I won’t be able to make a crop next year. I can pay you or I can buy a mule.” The doctor said without hesitation, “Buy your mule. You can pay me next year.” And he did.

    The suits would never have allowed something like that to happen.

    You are serving a noble calling. To hell with all the profiteering crap. Keep telling it like it is. Peace.

    Liked by 2 people

  16. It bothers me to realize what a racket all this is. Our health is such a frightening and sensitive issue. I understand these corporate boys are not making the patient sicker, just writing him / her up that way… but even so… it creeps me out.

    Liked by 1 person

  17. The ol’ “you’re not a team player” ploy. UGH! My husband retired 3 years ahead of schedule from Public Health Service because of layers of insanity and disrespect within the culture. I’m happy for him, for us, and look forward him continuing to work, but on his terms. More about that another time but I want you to know that you are not alone in fighting the good fight and my husband and I are rooting for you. And please do take good care of yourself, too.

    Liked by 1 person

  18. Fighting the corporate insanity can be tiring. Sometimes I use secret humor, in my own mind for comic relief. (What would a suit be like as a patient? Who will take care of the suits when they need health care?) Pick your battles. Like Angie said, take care of you, too!

    Liked by 1 person

    • Maybe. I cannot waste their time during office visits unburdening myself, though. We are there to talk about them. Which is why I started blogging. I wanted to increase awareness somehow, get things off my chest.

      Like

      • I’m sure many of us read your posts and become more understanding of our doctors. I know I do! Reading your posts remind me to always sincerely briefly thank my GP and psychiatrist whenever I see them, because I’m starting to realise the great job they do in a flawed medical system. I still put my healthcare needs first, of course, but I’m a lot more patient about the long waits because I know they really do try their best to give each patient the care they need, plus I’ve learned to meditate while waiting lol.

        Liked by 1 person

  19. Don’t be so hard on yourself for not measuring your words with those types. I don’t think it would make a difference. Wrong audience, wrong level. And, with your gender, it would take numbers, I think. So it is fantastic that you vented. Fantastic for you, and perhaps fantastic for the big picture: If more doctors did so, THAT might make a difference. In colonial days, when tax collectors were tarred and feathered, it became difficult to find people willing to collect taxes.

    Liked by 1 person

  20. One day, maybe one day, they will need your help. And then you can smile at them and think about what could go wrong and where they would be if they would be with the wrong insurance. And maybe they might be. And you can still treat them. And who knows, maybe they will figure out that there is more to this world than just numbers…

    Liked by 1 person

  21. AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAARGH.

    I know it probably seems like I say that a lot, but I really do try to reserve it for special situations of frustration so immense I can find the right words–or even words–to express my frustration straightaway. Also, I used lots of extra letters to express extra frustration, so this is different than my typical “argh.”

    So frustrated. So frustrated just reading this. I would have a hell of a time sitting in those meetings. Nix that: I do have a hard time sitting in those meetings when my end goal isn’t even healing people. To have people in a line of business reflecting their urge to heal be so greatly, routinely and matter of factly inhibited from healing is … holy shit, it’s mind-boggling. The fact that people get paid lots of money to inhibit your ability to heal (or maximize their dollar for your time, as I’m sure they’re thinking about it) is … AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAARGH.

    Up until that last several months, I thought I could more or less fit myself to any job. I’ve felt really heavily how the burden of bills falls upon me, and have thought about work recently as trying to pay those bills. I truly thought I could find the good in any job and make it work. Now I’m understanding there are things I do need from a job beyond a paycheck and stability. I have a sense of what these are, but I haven’t articulated them yet. For now, I’d say they’re the opposite of meetings like those you describe in this post. If it were just a matter of one bad meeting, hey, we all have bad days. But when that bad meeting is actually just the tip of the wrong thinking iceberg? That’s way too much of the wrong kind of challenge. Right now, I’m coming to learn that I love a challenge. I love puzzles to solve, and environments that support unique ways of solving them instead of further trying to dictate exactly how and where and on what size of table each puzzle must be solved. At that point, my work might as well be done by a robot. And we’re just not robots. We’re people meant to be and learn and grow and be treated as people.

    That’s why I’ve loved reading Liz Ryan’s LinkedIn blogs recently. But for her, I’d think that my longing for these things was some crazy pipe dream; reading her, and seeing other people have great success implementing her suggestions, makes me excited for what’s to come. I just wish that “what’s to come” would be everywhere, because whoa. Workplace disengagement would be diminished, and work would again have the possibility of being a place where folks are enabled to solve problems instead of jumping through hoops.

    And all this, again, for a non-healing profession. Reading about this crap being applied to healing professions fills me with ire.

    AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAARGH.

    Liked by 1 person

  22. As long as the medical system of care revolves around patients and their treatment you can still be a great medical professional.

    When corporations change the focus of care to business model R.O.I. people will walk out at some point. The veteran scandal was already enough to wake up the watchdogs.

    Treat the elderly, disabled and future elderly like walking ATMs and even the Washington has to intervene. You cannot call you country “developed” or “Western” when you treat the ill like garbage.

    Ask the “salesmen and saleswomen” about their parent and witness them breaking down into lumps of frailty, poker faces and all…

    Liked by 1 person

  23. Thanks for sticking to your guns. You never know when it will change things. I Ihad been managing the acute dialysis unit in my hospital for twenty years when they decided to contract dialysis services from a nationwide company. They wanted to hire me with the provision that staffing be changed. Instead of of using a 1 RN :1 or 2 pt ratio we would go to 2 nurses total filling in with non professional staff. I refused the job, based on unsafe staffing, knowing it would be catastrophic for patient care. The first day this staffing was implemented, one patient died and one fell out of bed, sustaining a serious head injury The company asked me to come back, but I refused, feeling I couldn’t trust them, based on their business model.

    Liked by 2 people

  24. Worst of all, Doc, it makes me wonder if that’s what they want: The best docs like you to rant out, fume away, and either leave on their own or don’t play the game so markedly that they can get rid of you and replace you with cheaper and easier to herd alternatives.

    Liked by 1 person

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