As a physician, the rise of nurse practitioners has been the ultimate slap in the face. This is something we’ve given our lives to, then we see untrained posers slip into our role like a pair of cheap pants.
Hospitals expect us not only to cover for them, but to treat them as peers. Not only that, but we can no longer trust any referral or read or test at all. The stories are legion. It is the ultimate insult to many of us; and I don’t see where this fits in the superfecta.
I’ve read about the rise of nurse practitioners and the elevation of their authority some years ago. At the time, I remember vividly thinking to myself about the impact of this, and about the length of time before PhDs, MDs, etc., face the reality that some of us -who do not often find themselves with a need for medical attention, but who have in the back of their minds a sense of “security” knowing that such attention, when needed, will be conveyed by none other than those PhDs, MDs...- are starting to wonder what is the doctor for aside from being a rubber stamping admin if the NP is the de facto face of the medical profession?
Your post, I believe just answered that for me.
Having said this, the topic brought here by Mr V is one that, as the author himself self admits, is very much applicable across many organizations, and expands beyond just the medical field. Anyone with a leadership mindset, not just position, will benefit greatly from pondering the same questions and looking for solutions.
This is important. The most frustrating thing I see as a patient and observer of my loved one’s experience, I now realize contributed to my early retirement from clinical practice. It is a lack of time and attention to proper communication and follow through with the patient from the intention set by the doctor to the delivery of intended services. As a practicing physician, I had to pick up the slack in this aspect of the system personally and it took a toll.
Systems need to be in place to automatically advocate for every patient and lead them through the steps of their care. The onus shouldn’t be on the patient to badger for appointments to be made, referrals to result in closing the loop communication (that includes the patient), tests and procedures to be approved, scheduled and reported and acted upon in a timely way etc.
So many excellent doctors report they can’t fix it or it is out of their control. We need to fix this as a system or build in these resources for both patients and doctors. The lack of success in this essential aspect of care reduces patient confidence and safety, which
In turn negatively affects outcomes. Worse yet it leads to doctors burning out and patients walking away in frustration only to return sicker later. We shouldn’t have patients and doctors both just giving up.
Ha... yes. It's a high bar for sure, but I feel for large organizations approximating these goals on some level won't be an option. In pediatric emergency medicine, as one example, the flight from the field since COVID has been alarming. It's multifactorial, for sure, but we have to consider trying to achieve some of this if we are to retain our hard won talent. This attention to professional satisfaction is a relatively new pursuit since initially physicians were largely 'self sufficient' in self-governed practices. More are now working within larger organizations. And now these systems see organized labor leeching in to postgraduate training programs -- programs breeding the next generation of physicians. Lots to say about this. Maybe another 'stack...?
From a patients perspective; must have confidence that your MD is free to implement treatment that is, based on the MDs experience & knowledge. Not directed by legal, insurance, hospital alliance procedural considerations before the health issue. Bottom line, the patient makes decisions & the MD is his advocate who wants to feel the patient has confidence in the MD.
Great piece, as usual. Overall, I think your framework is a modification of Maslow's hierarchy. At the top of the pyramid is self actualization, in the middle of the pyramid is professional success, but the bottom of the pyramid is, what I would describe as, hygiene.
"Hygiene" can be defined as personal safety, adequate workspace, the maintenance of mental health/avoidance of burnout. We know that if the bottom rung of the pyramid is not provided, it is impossible to move up the hierarchy. In other words, the only thing hygiene grants is mitigation of dissatisfaction. But it is absolutely necessary to have hygiene to achieve self actualization.
TY Michael. I hadn't considered professional hygiene here but it's critical to any hierarchy like this. Simon Sinek has written extensively on the need for 'safety' in the workplace. This has been absolutely overlooked for physicians. As we see organized labor creeping in to post graduate training, much tighter attention has to be paid to these things.
Is part of the doctor crisis, the idea that doctors are people too, charged with authority to take care of others as much as themselves?
That is not a given in what you’ve written. Doctors extra ability to work through the so called Invisible Enemy (eer Trump) in the war on disease (per Bidens behavior) was driven by declaration… by governments following WHO following allies of Dr Science himself. It was military grade BioMedicine for a BioSecure BioEconomy.
Data showed early on, and even more so now, that MDs could uphold procedural duty to get through the pandemic just fine, with overtime.. But sadly, those taking their own uninformed rote advice are at higher risk of dying suddenly just like their patients.
Shocking, So if I back up a bit, readers might think, but can’t assume, your superfecta aims to promote groupthink in a closed community of self lauditiry experts.
Data supports argument that if there is a crisis then it might have to do with dear MDs grasping at steady pay whike following arbitrary procedures with relatively, if not complete disregard for patient condition and variability. The problem is that such grasping through Covid and to this day, is based on expert labels. Doctors paid no heed, but not ‘reckless’ in disregard.
Good news, Doctors aren’t responsible for deaths. Sadly doctors, nurses and highly injected professionals died too (per excess mortality numbers jumping post operation warp speed), like uninformed patients.
And the MDs who ask questions snd work to protect their patients from ill-treatment by Covid countermeasures, have either had their licenses revoked or have been silenced by less inquisitive medical experts and purveyors of propaganda.
The crisis may be that humans need to behave in more humane ways if they want to feel confident about life…especially if they are in the black art of the white coat, and want back up on top of that ethical/practical pedestal they once held, it used to be so high, we all used to feel our doc was a god.
Well, what if we quit dehumanizing one another and start working on the basis that every patient is a person who is alive and putting their life in your hands. Life is sacred. Even if you are working in emergency medicine, that understanding is part of the job.
If you agree at all, where does such sensibility and fit in your suoetfecta.?
As a physician, the rise of nurse practitioners has been the ultimate slap in the face. This is something we’ve given our lives to, then we see untrained posers slip into our role like a pair of cheap pants.
Hospitals expect us not only to cover for them, but to treat them as peers. Not only that, but we can no longer trust any referral or read or test at all. The stories are legion. It is the ultimate insult to many of us; and I don’t see where this fits in the superfecta.
Greetings Sir
I’ve read about the rise of nurse practitioners and the elevation of their authority some years ago. At the time, I remember vividly thinking to myself about the impact of this, and about the length of time before PhDs, MDs, etc., face the reality that some of us -who do not often find themselves with a need for medical attention, but who have in the back of their minds a sense of “security” knowing that such attention, when needed, will be conveyed by none other than those PhDs, MDs...- are starting to wonder what is the doctor for aside from being a rubber stamping admin if the NP is the de facto face of the medical profession?
Your post, I believe just answered that for me.
Having said this, the topic brought here by Mr V is one that, as the author himself self admits, is very much applicable across many organizations, and expands beyond just the medical field. Anyone with a leadership mindset, not just position, will benefit greatly from pondering the same questions and looking for solutions.
This is important. The most frustrating thing I see as a patient and observer of my loved one’s experience, I now realize contributed to my early retirement from clinical practice. It is a lack of time and attention to proper communication and follow through with the patient from the intention set by the doctor to the delivery of intended services. As a practicing physician, I had to pick up the slack in this aspect of the system personally and it took a toll.
Systems need to be in place to automatically advocate for every patient and lead them through the steps of their care. The onus shouldn’t be on the patient to badger for appointments to be made, referrals to result in closing the loop communication (that includes the patient), tests and procedures to be approved, scheduled and reported and acted upon in a timely way etc.
So many excellent doctors report they can’t fix it or it is out of their control. We need to fix this as a system or build in these resources for both patients and doctors. The lack of success in this essential aspect of care reduces patient confidence and safety, which
In turn negatively affects outcomes. Worse yet it leads to doctors burning out and patients walking away in frustration only to return sicker later. We shouldn’t have patients and doctors both just giving up.
If your hospital system achieves something even close to this, you should sell it. You’d make gazillions.
Ha... yes. It's a high bar for sure, but I feel for large organizations approximating these goals on some level won't be an option. In pediatric emergency medicine, as one example, the flight from the field since COVID has been alarming. It's multifactorial, for sure, but we have to consider trying to achieve some of this if we are to retain our hard won talent. This attention to professional satisfaction is a relatively new pursuit since initially physicians were largely 'self sufficient' in self-governed practices. More are now working within larger organizations. And now these systems see organized labor leeching in to postgraduate training programs -- programs breeding the next generation of physicians. Lots to say about this. Maybe another 'stack...?
From a patients perspective; must have confidence that your MD is free to implement treatment that is, based on the MDs experience & knowledge. Not directed by legal, insurance, hospital alliance procedural considerations before the health issue. Bottom line, the patient makes decisions & the MD is his advocate who wants to feel the patient has confidence in the MD.
Great piece, as usual. Overall, I think your framework is a modification of Maslow's hierarchy. At the top of the pyramid is self actualization, in the middle of the pyramid is professional success, but the bottom of the pyramid is, what I would describe as, hygiene.
"Hygiene" can be defined as personal safety, adequate workspace, the maintenance of mental health/avoidance of burnout. We know that if the bottom rung of the pyramid is not provided, it is impossible to move up the hierarchy. In other words, the only thing hygiene grants is mitigation of dissatisfaction. But it is absolutely necessary to have hygiene to achieve self actualization.
TY Michael. I hadn't considered professional hygiene here but it's critical to any hierarchy like this. Simon Sinek has written extensively on the need for 'safety' in the workplace. This has been absolutely overlooked for physicians. As we see organized labor creeping in to post graduate training, much tighter attention has to be paid to these things.
Is part of the doctor crisis, the idea that doctors are people too, charged with authority to take care of others as much as themselves?
That is not a given in what you’ve written. Doctors extra ability to work through the so called Invisible Enemy (eer Trump) in the war on disease (per Bidens behavior) was driven by declaration… by governments following WHO following allies of Dr Science himself. It was military grade BioMedicine for a BioSecure BioEconomy.
Data showed early on, and even more so now, that MDs could uphold procedural duty to get through the pandemic just fine, with overtime.. But sadly, those taking their own uninformed rote advice are at higher risk of dying suddenly just like their patients.
Shocking, So if I back up a bit, readers might think, but can’t assume, your superfecta aims to promote groupthink in a closed community of self lauditiry experts.
Data supports argument that if there is a crisis then it might have to do with dear MDs grasping at steady pay whike following arbitrary procedures with relatively, if not complete disregard for patient condition and variability. The problem is that such grasping through Covid and to this day, is based on expert labels. Doctors paid no heed, but not ‘reckless’ in disregard.
Good news, Doctors aren’t responsible for deaths. Sadly doctors, nurses and highly injected professionals died too (per excess mortality numbers jumping post operation warp speed), like uninformed patients.
And the MDs who ask questions snd work to protect their patients from ill-treatment by Covid countermeasures, have either had their licenses revoked or have been silenced by less inquisitive medical experts and purveyors of propaganda.
The crisis may be that humans need to behave in more humane ways if they want to feel confident about life…especially if they are in the black art of the white coat, and want back up on top of that ethical/practical pedestal they once held, it used to be so high, we all used to feel our doc was a god.
Well, what if we quit dehumanizing one another and start working on the basis that every patient is a person who is alive and putting their life in your hands. Life is sacred. Even if you are working in emergency medicine, that understanding is part of the job.
If you agree at all, where does such sensibility and fit in your suoetfecta.?