The part about the doctor-patient relationship that the “bean counters” can’t get

Over the last several years since I graduated from residency, I’ve worked in many different hospitals up and down the east coast. These have ranged from large urban medical centers to rural community outposts. In all of these places I’ve felt the inevitable conflict that exists between physicians and administrators—to varying degrees. It almost seems like a rite of passage that the world of clinical medicine and administration are at loggerheads with each other in healthcare. Sad, but true. I’ve personally worked with some very inspirational administrators (rare) and also some fairly terrible ones. Generally I’ve noticed that the best and most respected administrators have been physicians (or even nurses) themselves, with many still doing clinical work to stay in touch with the frontlines. Experience has therefore taught me to be very careful with any job search, and observe carefully the “state of the administration” before signing on the dotted line. I feel I’m now finally at a place where the relationship in the hospitals I work in is fairly good, but getting there has certainly had its ups and downs.

One of the palpable drawbacks in the worst places I’ve worked, that has been a consistent theme, is that administrators completely fail to grasp the realities and rigors of the frontline practice of medicine. They are all too quick to enforce mandates and band around terms like “patient satisfaction” like bumper stickers, but lose the forest for the trees in terms of reasons why their ideas are unsuccessful. A further trait in the very worst administrators (and remember, many of these people have a shelf life of less than a year or two) is that they almost pour scorn on the doctor-patient relationship and the sanctity of that trusted interaction. Why do they do this? Because to lots of them, it is something that they can’t quantify or understand (until that is, they or a loved one are in need of a good doctor). It’s incomprehensible to those who are only in the business of medicine that there’s an entity like this that is outside their reach. The same goes for other administrative folk, including the healthcare information technology crowd. In their world, everything is about numbers, big data and measurements. It’s all click boxes, mandates and the bottom line. The problem however for them is that healthcare will never be like that. No matter what changes occur in the business and administration of medicine, healthcare will always be about real people and human beings. It’s an emotional arena in which that doctor-patient interaction still remains paramount.

While not all administrators are bad or completely out of touch, the downstream consequences of having a “bad administration” which is perceived as alienating or not understanding their frontline staff, are a huge liability for any healthcare organization.

If you are physician who is currently frustrated with your administration because they don’t “get it” (and I have numerous friends and colleagues across the United States who are in this boat), take solace in the fact that you are a highly skilled professional who is very valuable to your patients. Realize that your level of education and training, along with your professional judgment, is way more than most. The bond that you get to form with your patients is special and unique. And above all, remember that your skills are transferable anywhere and that those administrators who may irk you the wrong way are very much here today, gone tomorrow.

 

Suneel Dhand is a physician, author, speaker and healthcare consultant. He has experience in a number of different healthcare environments, having worked up and down the East coast and also internationally. His specialty areas include hospital QI, optimizing healthcare IT, and improving the patient experience. He is the author of 3 books, including most recently “The Ultimate Patient Advocate in Your Pocket”, designed to help hospitalized patients. He is also the founder of HealthITImprove, an organization dedicated to improving and optimizing information technology at the frontlines of healthcare.

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