Samuel Shem's House of God 2012: Healthcare failures hiding behind paper

When Samuel Shem published his famous book The House of God four decades ago, no one would have thought that American medicine could fall so far from its elevated position in society. Photo: Author

SAN DIEGO, Monday March 12, 2012—When Samuel Shem published his famous book The House of God four decades ago, no one would have thought that American medicine could fall so far from its elevated position in society.

Doctors once stood as pillars of medical decision making. Now, they are now mere “providers”; hospital administrators need medical doctors, but only to serve quietly in their schemata to keep onerous regulators and government officials at bay. As one health system CEO arrogantly announced to her chief of staff committee, “you give the care and then stay out of our way.”

Today, doctors are rarely considered important in the sense of true democratic input and leadership. As the federal government assumed greater power and influence over the practice of medicine over the past two decades, physicians became increasingly marginalized as ‘necessary baggage’ to the healthcare equation.

Despite an average of 11 to 17 years of education and training after high school, with arguably the most arduous and demanding academic curriculum and graduating with as much as a half million dollar debt from the cost of their education, physicians are chided about their ‘elevated’ income levels.  Many bright students are dissuaded from pursuing the noble profession of medicine because of such misplaced stereotypes and negative connotations associated with the current health care reform law.

While the knowledge and skill of physicians is irreplaceable, it is an inconvenient truth which many hospital CEOs would like to keep hidden from sight. They would rather focus on government-mandated surveys, cumbersome computer system dictates, and (largely meaningless and often falsified) ‘pay for performance’ statistics that show their compliance with Uncle Sam’s guidelines. If the right paperwork is presented to their bureaucratic overseers, then hospitals get more money from the taxpayer coffers. Likewise, attention to government mandates insures that penalties and fines are avoided.

All of this comes down to the simple truth of hospital politics in today’s era of big government and the current healthcare reform law: quality and outcomes are secondary to political whims and trends. Today, billions of dollars are spent annually in the United States instituting and maintaining computer networks, and in preparing for ‘joint commission’ surveys that may do more harm than good for patient care.

Any honest member of the healthcare profession will attest to the fact that preparation for government surveys is merely a dog and pony show. Unannounced surveys are rare; most are planned in advance and involve temporary fixes and facades to give a false impression of how care is actually delivered. Once the survey is complete, processes and practices are converted back to the norm. Surveyors know this, and so do doctors and nurses; it’s all part of a game that wastes time, money, and precious resources.

Aside from data storage, transfer, and retrieval, the vast majority of hospital computer systems take attention away from patients, focusing the user instead on the monitor and keyboard. Patient data can be accessed easily, and in bulk, from remote locations, but privacy concerns remain significant as data is vulnerable to unauthorized access from anywhere in the world.

Furthermore, the clinical data bank is only as valid as the integrity of data entry performed at the bedside or ward. A dark and secretly held concern of hospital-based information technology (IT) specialists is that a significant percentage of data logged into the system may actually be inaccurate or attributed to the wrong patient.

You won’t find a large scale study that attempts to quantify this problem, but IT workers will off-handedly report a disturbing number at around 5% for incorrect data entry (i.e., reported by doctors, nurses, and lab technicians at some point after the time of entry). How many mistakes in the digital patient record are actually never caught or corrected? Is this figure actually closer to ten or even twenty percent?

How many clinical decisions have been made based on false data? How many patient injuries have occurred due to this system-based vulnerability? Why is the government silent on this issue?

Herein lies the dilemma we face in the modern age of government-controlled medicine: decisions to purchase software, hardware, clinical tools, and supplies are no longer based on across-the-board sampling of physician and nurse judgments or preferences. Instead, they are pushed downward from politicians and bureaucrats whose primary concern is not quality but conformity... Once mandates become ‘top-down’ instead of ‘bottom up’ in the medical delivery system, all bets are off when it comes to the end result. The ‘result’ will often be manipulated to insure that government dollars continue to flow, regardless of true clinical outcomes.

Like America’s military fighting force, medical professionals in the United States are the best of the best. The quality of nurses and medical doctors in America is unrivaled the world over.  Similar to the military’s inefficient and often incongruous layers of administrative rules and procedures, the civilian hospital system is anything but ‘creative’ or ‘innovative’.  The accountants, nurses and doctors who rise to the top of their local hospital boards today seem more concerned with avoiding the wrath of their government taskmasters than anything else. Driven more by fear than incentives to streamline and innovate, today’s hospitals are cauldrons of waste and stifled talent.

If you take partisanship out of the debate on the ‘Affordable Care Act’, many medical professionals will tell you that their biggest professional angst is centered on their role in giving good care. The government’s involvement in the healthcare system should be one of limited observer and protector of patient and ‘provider’ rights—i.e., preservation of the doctor-patient relationship.   Instead, the government’s inflexibility, and its adherence to oftentimes ill-conceived mandates, has become a burden and a liability to quality.

When hospitals stop becoming mere thugs, who blindly enforce often wasteful and meaningful ‘reforms’, and start becoming true partners to doctors and nurses, patients will benefit.  The free market is anything but irresponsible when it comes to quality, and healthcare is no exception. 

Ask any doctor or nurse what they love the most about working in the ‘house of God’ and they will say it is helping patients.  Find a way to put patients—not the government—in the driver’s seat, and you’ll find that the highest quality, most affordable medical care is well within our reach…and you won’t need 2,700 pages of laws to achieve it.


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Adam Frederic Dorin, M.D., MBA

Doctor Dorin is a Hopkins-trained, board-certified anesthesiologist, practicing in a large group in San Diego. He is a small business owner, a Commander in the US Navy Reserves, and the Founder/President of America's Medical Society, Inc., (AMS) a non-profit corporation created to serve and educate physicians and the general public in matters of national health-care reform and medical politics

Contact Adam Frederic Dorin, M.D., MBA

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