THREAD: This isn’t just about whether doctors should get “hazard pay” (which they should)

It’s symbolic of our f*cked up healthcare system which relentlessly exploits altruism of our doctors and nurses

1/x https://twitter.com/colleenmfarrell/status/1252241169758773250

What’s esp problematic here is willingness of admins to use heavy handed tactics to shut docs down

Admins refusing to hear concerns of those on front lines lead to bad decisions for patients & HC workers

2/x

Emails from hospital leadership show clear apathy towards physican concerns, willingness to use bully pulpit to silence concerns

Note threat to trainees in this email: “Also, can we see who has their names on that petition?”

3/x

https://www.reddit.com/r/medicalschool/comments/fyubw2/residency_what_nyu_langone_really_thinks_of_its/?utm_source=share&utm_medium=ios_app&utm_name=iossmf

Same hospital system has been notorious during #COVID for doctor muzzling of workplace safety concerns

I’m not surprised at their poor treatment of medical trainees

4/x

https://www.wsj.com/articles/nyu-langone-tells-er-doctors-to-think-more-critically-about-who-gets-ventilators-11585618990

Throughout this crisis, hospital admins have leaned on PR reflexes ingrained in them from business school

The less bad news, the better

Control messaging. Protect the brand’s reputation

https://www.vanityfair.com/news/2020/04/hospitals-crack-down-on-covid-19-complaints

5/x

Except in a pandemic, that’s just NOT possible. Bad news is everywhere

Muzzling of doctors has adverse effect on patient care and outcomes!

Truths from front lines that must get out so policy makers & elected officials make better decisions get BLOCKED

6/x

The dangerous consequences of HC systems driven by revenue, led by non clinicians are coming to light during #COVID

Patient well being, physician safety get shuffled into mix of other priorities

Institutional reputation & protection of revenue are VERY important to admins

7/x

How to we fix this? Something that won’t happen overnight and I haven’t researched this enough to say I have a great solution but here are my opinions

cc: @danielleofri @EricTopol

8/x

ALL hospital admins should have at one point in time been a practicing clinician

No MBA only admins should be allowed to reign freely over a HC delivery system when they have ZERO experience with patient care

Would you ask an MBA only to cut out your appendix?

9/x

Dumb decisions and opinions by those who have never examined or diagnosed a patient is why our HC system is a complete mess

i.e. healthcare “policy” wonks/economists have pushed HC “quality improvement” ideas w/ lots of negative unintended consequences i.e wonksplaining

10/x

Just because you have former clinicians in charge doesn’t mean all the shenanigans will stop

Plenty of admins with RNs and MDs behind their name make dumb decisions that front line docs disagree w/ because they become out of touch!

11/x

My proposal: admins should be required to practice or work in clinical practice in some way part time

Will keep them abreast of what’s actually affecting docs, nurses & patients

Also will lead to improved collegiality and collaboration btw admin and frontline HC workers

12/x

Another radical but necessary step: legislate these requirements for all hospitals to be able to maintain their non profit status

Non clinician administrators have a choke hold on medicine and certainly won’t leave quietly

Their bonuses depend on it!

13/x

With PRACTICING clinicians in charge, priorities of hospitals will change

Reputation/branding/PR and revenue will still be important for hospital to function

But practicing clinicians will be less likely to allow those priorities to supersede patient care & wellbeing

/end