John Nelson writes…
Three articles caught my eye recently.
The first is an editorial in the New York Times by Peter Orszag that is getting a lot of attention. It is well worth reading, and part is devoted to making the case that hospitals should provide the same services (or nearly so) 7 days a week. That means things like elective surgery and MRIs should be just as available on Saturday and Sunday as other days, and that hospitals should be staffed by essentially the same complement of doctors (and presumably other clinical staff) on weekends as on weekdays.
Providing some balance is a pair of thoughtful and well written essays in the current Annals of Internal Medicine (here and here; subscription required). They both provide a vivid (idealized?) and moving description of the way things used to be: doctors who were devoted to the needs of their patients above all else. And how they seem now: doctors spending way too much time in meetings and learning how to do things like document/bill/code their services so that they’re left with only 12 minutes to spend with each patient.
Requiring doctors in most specialties (even dermatologists!?) to provide the hospital with the same staffing and availability on weekends that they provide on weekdays will likely accelerate the move toward many specialties adopting the hospitalist model. And while that might not be a bad things, it will probably also accelerate the trend for doctors to become employed by hospitals, which in turn might make it more likely that hospital care is reimbursed through bundled payments to the hospital or a 3rd party rather than reimbursing the hospital and doctors separately. All this will probably hasten the pace of evaporation of “the way things used to be” in medicine. Doctoring will continue to look a little more like a job and less like a profession or calling. The Annals editorialists should plan to write a future article saying “I thought things had gotten bad by 2010, but medicine has continued to become a more impersonal grind.”
You may think I’m opposed to increasing weekend physician staffing at hospitals. But I’m not. For my more than 20 years in practice “my” hospitalist practice has always regarded weekends as just the same as any other day; they’ve always had the same staffing. And I think doctors in most other specialties should do the same. (And they would presumably end up taking a lot more weekdays off than they do now, just like hospitalists.)Orszag makes this case pretty well in his NYT editorial. Even if such a change has the unfortunate side effect of making medicine increasingly impersonal, etc, the net effect for patients is likely to be good. So I can’t wait to get there.
Taking away many of doctors’ weekends off will be painful, but if it is good for our patients and increases the efficiency/value of the care we provide, then we should figure out how to make it happen. Thoughtful people like the Annals editorialists will continue to remind us of what doctors and patients risk losing in the process and it will be up to everyone in healthcare, including patients, to figure out how to preserve it.