Monday, July 26, 2010

Morning Minyan

On Sundays if not on call I try to attend minyan for Kaddish.  We generally get ten plus men, no women other than the wife of one of the regulars who makes the coffee, for which she gets little audible appreciation, though I try remember to thank her most of the time.  After minyan today, somebody engaged me in serious conversation, though this does not happen often.

A medical colleague shared my interest in a Medscape Physicians Connect thread on doctors who voluntarily give up their hospital privileges.  As part of the thread I had posted a symposium published by the Cleveland Clinic Journal of Medicine entitled "A Medical Center is not a Hospital" by Dr. Thomas Lansdale, which invited numerous spirited comments.  Shortly before publication, I had resigned from one of my hospitals, largely because I did not like their rabbi.  When comments were invited, I sent a rather lengthy and detailed response which made it to the online version of the CCJM, though not the print one.   As part of the Medscape thread I linked the CCJM comments, receiving much thanks for my rather brief contribution.  Eventually the issue of resigning from a hospital staff, or staying on grudgingly, garnered a couple hundred physician responses, far more than the usual Physicians Connect discussion.

The reasons cited are expected quite varied.  Dr. Lansdale cited primarily professional and ethical frictions between the goals of hospital management, of which he was part by his role as section chief, and his resposibilities to provide the patients for whom he and other members of the Department of Medicine are responsible with the finest in medical management for the illnesses that came their way.  Some of that reasoning continued on the Medscape Physicians Connect commentary.  However, much of it involves personal experience more than committment to patients.  Hospital generate ample income for some of us but for others it absorbs time without offsetting economic or professional benefit.  Many of my medical colleagues point to villains who have ruined it for them.  There are insurance companies that restrict decisions as basic as to when to hospitalize somebody.  There are managers who pounce on them for expressing themselves with visible or audible irritation when nurses fail to do what the physicians expect them to do.  There are foreign trained physicians and nurse practitioners who take their business away by agreeing to either work for less or join the hospital payroll.  There is the Democratic Party or the Republican Party whose policies or legacy provides a point of irritation.   There are colleagues who steal their patients. Stephen Covey in his monumental 7 Habits of Highly Effective People describes people who's fundamental goal in life is to stay a step ahead of their enemy.  These people really have very little proactive autonomy as their decisions are generally a byproduct of the people they need to protect themselves against.  Yet that theme seemed highly pervasive in the physician comments.  In that sense, resigning from a hospital staff enables a measure of desired escape.

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