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LETTER TO THE EDITOR
David A. Lipski, MD
T
o the Editor:
Dr. John Roberts’ piece “Unhappy Doctors Make for Unhappy
Patients” in August’s Louisville Medicine
had me saying to myself, “Yes,” “That’s
right,” and “Amen.” Most GLMS presidential columns do. I would like to offer
a few thoughts about the sentence, “It
is commonly stated in doctors’ lounges
that those physician leaders, having now
found themselves in leadership positions,
seem to have drank too much of the corporate Kool-Aid. Many physicians have
expressed the feeling that these physician
leaders have sold out and no longer watch
out for patients or the doctors.”
Surely these sentiments are stated and
are believed, so Dr. Roberts’ assertion is
correct. Whether the sentiments are true
is different. Even a brief time in leadership
has taught me that problems are seldom
as straightforward as they seem. Leaders assimilate input from different, often
vigorously opposing, points of view. The
simplest reaction often does not address
every important dimension of a problem. Financial questions represent ready
examples. Most of the fat and even part
of the meat have already been trimmed
from every budget. Money to address your
problem must be taken from someone
else, because health care at our level is a
zero-sum endeavor. From whom should
we take it? How do you feel when money
is taken from you? Making decisions when
you know someone will be disadvantaged
no matter what you decide is really hard.
Like most, I have from time to time been
frustrated by seemingly dumb solutions
coming down from above. Really? This is
what we’re going to do? The feeling softens
when someone quietly explains private details that change my initial opinion entirely. Oh, now I see. Often leaders cannot divulge all factors that impacted a decision.
In particular I have been surprised by the
number of decisions that protected physicians, their practices and their patients in
ways they do not know, but looked foolish.
Yet leaders quietly allow themselves to be
thought of as buffoons. It comes with the
role.
Finally if being educated about health
care operations means drinking the KoolAid, then so be it. It would not be the first
time. Patients might say we all sold out
when we went to medical school, a giant
Kool-Aid party. Consider these aspects of
administering a health system or medical
group: finance, organizational structure
and behavior, human resources, strategic planning, regulation, compliance, risk
management, and quality. To be clear,
none is as important as the doctor-patient
relationship and the care that comes of it.
It’s priority one. But without the others,
that relationship can no longer exist. Not
now. Leaders are trying to function effectively in a messed up system they did not,
and would not, invent, just as physicians
are. As practicing physicians, we think of
corporate “suits” and physician leaders as
thorns in our sides because they seem to
make our lives so difficult. Just leave us
alone and let us practice, we say. To physician leaders, the federal government is the
bane. Just leave us alone and let us run our
organization, they say. The core problem is
(a perverted version of) The Golden Rule:
He who has the gold makes the rules.
Dr. Lipski practices vascular surgery as
well as venous and lymphatic medicine at
the KentuckyOne Vein Care Clinic, a practice he established through KentuckyOne
Health.
NOVEMBER 2016
27