Should We Fight for the Top 100 Billing Doctors?

Life is full of hard choices.

Imagine a bully beating up your little brother.

The bully is bigger and louder than you and your brother.

If you run for a teacher, it would be too late.

You could fight the bully and lose. Or you could cut your losses, and run away. Your brother should have avoided the bully in the first place.

Consider a slightly different case in which a bully is beating up your older brother. Would your options change?

To Fight or Not to Fight

Benthamites would run away in both cases. Jeremy Bentham, the father of Utilitarianism (or Benthamism), said we should seek the greatest happiness for the greatest number of people.

Happiness means maximum pleasure and minimum pain. Utilitarians would assess the bully, weigh the odds, and run away. They call it felicific calculus.

Utilitarian calculus created the Poor Laws and workhouses of 1834, described in Dickens’ Oliver Twist.

Most people agree: We should not put citizens in workhouses or Hunger Games, even for the sake of peace and order. The end is good; the means are not.

Utilitarians focus on actions and consequences. If an action causes a good outcome, then the action is good. For utilitarians, consequences matter most.  Utilitarians do not focus on the agent doing the action or the intentions of said agent.

OMA and the Top 100

What does this have to do with the Ontario Medical Association and publishing the billings of the top 100 doctors?

On one hand, the OMA works to maximize happiness for the greatest number of its members. This works most of the time, but not when a small group comes under attack.

How many resources should the OMA divert from the many to expend on the few?

If the cost is small, is it good to fight even if we might lose?

Should we only fight when the odds are in our favour? Continue reading “Should We Fight for the Top 100 Billing Doctors?”

Should Doctors be More Accountable?

Some say doctors get away with murder. Hospitals CEOs stress about patients’ lengths of stay, often because doctors refuse to arrive early and discharge patients.

IT leaders groan when doctors mangle data entry. Health records departments lose their minds about overdue discharge summaries.

A former hospital CEO and management consultant took issue with my post: Experts Blame Doctors. He said this on social media:

“Your series so far has painted Drs as victims without much accountability.

Unfortunately, there are just far too many example [sic] of Drs acting total [sic] beyond accountability who seem to be protected by other Drs and their guilds. Like Dr God in Ottawa who fertilized eggs randomly with his own sperm who remained a member of the college in good standing for years.

Yes the payer and the patient can both have reasonable expectations that the practitioner doesn’t like. It is called work for a reason and pay has meaning.

A few suggestions about what your guild might do to be better would lend some credibility over this poor me stuff you have been putting out. Mix it up a bit like there might even be a public interest.”

Leaving aside Dr. God, for now, our CEO says docs might have “some credibility” if they offered solutions instead of “this poor me stuff you have been putting out”. Docs are unaccountable whiners. Continue reading “Should Doctors be More Accountable?”

Getting out of Medicine

Here’s a physician who’s living what many doctors daydream about. He didn’t just get out of medicine.

Read Matt’s post below to inspire your own dreams.

Enjoy!

Getting out of Medicine

I have a friend who, like me, is an emergency physician.  He’s also a racecar driver – and a damn good one.  He’s good not just because he’s got talent on the track but because he spends hundreds of hours working on and understanding his car.

For my friend, racing has been an antidote to the strain of medicine.  But it’s not enough.  He’s been burning out.

At some point it occured to me that my friend and his car are not so different.  They function in high-pressure, high-stakes situations, asked to perform optimally.  Mistakes are not tolerated.  Performance is the priority. 

Medicine and racing have a lot in common.

The difference is in the maintenance.  For example, my friend knows how important it is to change the oil in his car.  He knows that if he doesn’t there is a very predictable series of events that will ensue.

First, as the oil degrades, its ability to cool the engine decreases and the risk of overheating increases.  Second, as more debris accumulates in the oil, it thickens, decreasing the efficiency of the engine.  Finally, as metal on metal friction increases, engine damage occurs.  Ultimately, the heat generated can essentially weld the pistons and cylinders together. 

Catastrophic failure.

As I worried about my friend, it struck me that many physicians I know are like vehicles in various stages of neglect.  They are not functioning as well as they could.  Grinding on.  Damaged.

Physicians commit suicide three times more often than the population at large.  Something about modern medicine is toxic to our own well-being.  There is an epidemic of catastrophic failure.

Why do so many of us take better care of our cars than ourselves?  I think our system is inherently designed this way.

Continue reading “Getting out of Medicine”