Tag: #takebackmedicine

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Champions of Excellent Medical Care

Marion Mass, M.D., Practicing Physicians of America, co-founder

Female mature doctor examining little girl – closeup

Over twenty years ago, I was a fresh new attending, barely out of residency when called to the ER at three am to admit a patient with gastro and dehydration. I found a two -year old little girl, whose family spoke almost no English. She looked uncomfortable, her abdomen was distended, her platelets were slightly low and her potassium was slightly high. Her eyes had no sparkle. On her x ray, she had a paucity of gas in the right lower quadrant. These are all the signs of an intussusception, and needed an emergent enema to try to reduce the telescoping of bowel. The patient had been there for over four hours.

The ER doc, an old seasoned veteran was at the nursing station yukking it up with the nurses. I’m sure he had had a rough night. After I read him the riot act, for not calling sooner, I called the radiologist, who told me he’d handle it at six am when he came in. I politely told him I had no problem calling the hospital CEO and legal right away to let them know of the risk to patient and hospital. He came in immediately. (I offer mercy, as I don’t know what else in their lives these two physicians may have had that distracted them, and God knows, I have had my own mis-steps over 23 years)

All of us should call anyone who stands in the way of excellent patient care: “Disruptor of Patient Care”.

There are a subset of docs that will always speak for the patient, that would put their jobs on the line before they would allow shoddy or inappropriate care. A subset of administrators and government officials call us “disruptive doctors”. Nope. We are Champions of Excellent Medical Care. We are the ones America should trust for the solution.

Some physicians cannot be as vocal as the Champions of Excellent Medical Care. Many have gargantuan loans, many care for their parents, or have a houseful of children. We all must offer mercy to those physicians, who cannot be as vocal. Many of those physicians are spreading the word and supporting the Champions of Excellent Medical Care. The percentage of both of these groups are growing. We are ready to jump the chasm in the chart below.

Some physicians are tired, or scared, or disenchanted. Some are at the end of their career, and don’t want to become “champions” because they will have to call out friends in doing so. Friends that may have become administrators, politicians, industry players.

Some think we must move slowly, take measured steps. True patient champions have been woke for years, or now, newly woke, run to the long-existent code occurring in American medicine. We don’t aspire to place a band aid on a hemorrhage. COVID-19 has opened all of America to knowledge of how bad things have been.

Some physicians have not yet dissected the whole system to see and understand all the players who are the Disruptors of Patient Care. Please do so! Hint: FOLLOW THE MONEY!!! Here are two resources:

1.A primer on corporate care

2.Solutions and rationale for reducing cost and waste that will increase access.            The Free2Care white paper was presented April 2019.  The ideas are supported by the Free2Care Coalition: 8 million American patients and over 70,000 US physicians!  As a coalition of groups, each group does there thing and we come together surrounding ideas.  There is no one group in charge. Go team!

Some physicians know exactly how the system works and sold out, now working as leadership in organizations that take vast monies from the corporates. Some of these organizations have wonderful physicians who are foot soldiers, and are trying to change these organizations from within.  

I’ve had a tiny fear of being fired my entire professional life, for being a Champion of Excellent Medical Care, but deep down, I reasoned that if I put the needs of the patient first, how could I be doing the wrong thing?  Bottom line for all of us who want to be champions: allow us to give our patients, every patient, the best care possible If you choose to disrupt us, we will first ask you nicely to get out of the way, but then will breathe fire at you until you do.

That two-year old little girl… she got her enema, her intussusception was reduced, and the dull eyes I had looked into at three am were lit with a sparkle. I smile still thinking of that sparkle.

Jump the chasm, physicians of America. Sparkle. Do not be some physician: be the physician America’s patients need right now. Be the solution!

Be a stellar doc

Be a Champion of Excellent Medical Care!

With thanks to an old friend and a new physician friend for their inspiration. We all have many muses. I believe they are both champions.

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Scrubs vs. Suits — the Battle Inside the Nations’ Hospitals (Part 1)

Marion Mass, M.D.,  PPA co-founder

The headline to a news article dated March 25 on a recent Gallup poll was “Coronavirus Response: Hospitals Rated Best,  News Media Worst.”

 

The public’s low opinion of much of the news media is no surprise.  In polls, journalists have managed to work their way into a special zone of disdain occupied by some salespeople, lawyers and members of Congress. 

 

But there is a reality underlying what this poll says that probably would surprise the public. The physicians and nurses who work in the hospitals of which the public thinks highly do not always share that opinion.

 

That’s putting it mildly.

 

If the public understood what physicians and nurses really think these days about many hospitals and the way they are managed, the likely result of polling would look very different. The treatment by some in hospital management of nurses, physicians and many other healthcare workers in the direct line of fire during the COVID-19 pandemic would probably make the public think long and hard about putting the words “hospitals” and “best” in the same sentence.

 

Cynics could even be excused for wondering whether a hospital corporation bought that headline about the Gallup poll. 

 

On one hand, in the modern, corporate hospital, which may be a hub in a regional healthcare system, we have the “suits,” the executives in the C-suites, with the administrative, bureaucratic structure in which they function. They run the hospitals.

 

On the other hand, we have the “scrubs”—doctors, nurses, and others who change into the uniforms for dealing directly with the sick, uniforms that must be changed frequently and cleaned. 

 

For many weeks, the scrubs, the people “on the front lines” of the fight against COVID-19, have been receiving well-deserved acclaim as HEROES and SHEROES, as the ones risking their health, perhaps even their lives, to take care of others.

 

Remember: the scrubs don’t run the hospitals. The suits run the hospitals.

 

The quiet conflict between these two classes has been building for decades as hospitals have become increasingly corporatized, and more and more doctors have abandoned private practice to become employees. The bitterness of the conflict is generally kept from public view as people bite their tongues and get on with the job, trying to make the best of increasingly difficult circumstances. In any case, it’s not a story that the public, which is most concerned with access to medical care and cost, finds especially interesting.

 

If your antennae have been up during the pandemic, you would have picked up on disturbing and noisy eruptions of the underlying conflict from reports (we may not like them, but the news media have their place) such as these:

  

·   Nurses having to remove their personal protective equipment (PPE) because they were ordered to ration it.

·   Physicians and nurses being threatened with termination if they brought their own PPE to the job.

·   Threats of firing against and actual firings of employees (physicians) who spoke about the actual conditions of their work during the pandemic. 

 

A prominent spokesperson for the suits in hospital administration, Dr. Laura L. Forese, executive vice president and chief operating officer of New York-Presbyterian Hospital, has offered a perspective on the recent problems as someone who left her scrubs behind some years ago for a $3.4 million position in the C-Suite. In a video, she spoke of how “dispiriting” it is for her and other hospital administrators to receive e-mails of protest from weary physicians, nurses, and others describing what they are actually up against, e-mails alleging a lack of respect on the part of management.

 

We note here that Dr. Forese has been adept for years at making high-minded statements about hospital culture. She is a skilled spokesperson for those who decided to lock up the PPE and then retreated to their homes to work in their PJs.

 

In assessing the words of Dr. Forese, there’s something important to remember. The modern hospital corporation has a public face–the people who speak on behalf of the suits in the C-suites. Those spokespersons are masters of serving up a product marked by what the British euphemistically call “an economy of truth.”

 

It would not be politic, for example, for such a spokesperson to mention that at least some of the inhabitants of the C-suite have an entirely too cozy relationship with the Group Purchasing Organizations (GPOs), the huge business entities that control the supply chain for PPE and other hospital equipment—a dysfunctional supply chain that now stands fully exposed by the pandemic.  The Wall Street Journal and others have reported on the dubious nature of the relationship between hospital C-suites and GPOs, about whom we will soon have more to say in another blog entry. 

 

These relationships between suits in hospital C-suites and GPOs make those suits complicit with the GPOs in creating both the specific dangerous shortages that have been exposed by this pandemic and other shortages in recent years that have received almost no coverage. And this is to say nothing of the decline in the quality of what the GPOs supply to hospitals and other institutions involved in caring for patients.

 

But this is only one corner of a healthcare economy that has been emitting a stronger and stronger stench with the passing years.

 

In our next blog entry, soon to follow, we’ll discuss how this fetid complex has developed out of lobbying aimed at a receptive political class and at bending government agencies toward the service of very private interests. Fallen by the wayside in this process? The greater public interest in finding medical care at an affordable cost.

 

Until then, be safe. Protect each other and yourselves. Keep on being scrubs. It’s the honorable thing to do. 

 


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No time to rest, Practicing Physicians! In the middle of COVID19 battle, we must take back medicine for patients first!!

Marion Mass, M.D. PPA co-founder

Patients… it’s always been about you!!! The physicians that are putting themselves in the line of #covid19 🦠fire, are here for you and working alongside bedside nurses, respiratory therapists and every hospital personnel in scrubs. High time we were all a #stewardofmedicine! 👩🏾‍⚕️👨‍⚕️🧬

Were you there when the battle cry, #givemePPE (more accurately, #giveUSPPE came out? It was a rally point!!

For decades, perverse incentives that allow the BIG corporate quasi-monopolies to prosper, have been making sure that you, America, PAY more💰💵 and get less in health care.
It’s time to realign incentives that promote inclusive stake-holding. This would mean more patients able to capture medical care at a lower dollar value, paying less for health care. It would mean more practicing physicians able to treat you, the patients as we were trained, making enough to pay back the dozen years+ of education needed to become a physician. More bedside Nurses and more Respiratory Therapists and Physical Therapists and others able to support their families.

This means fewer paper pushing middlemen who are offering little value. Put simply, they are represented by monopolized BIG companies (Pharmacy Benefit Managers, Group Purchasing Organizations, hospital systems, insurance companies, Health Care IT, and pharma,) are robbing America blind, and many are RESPONSIBLE for all of the delays in test kits in getting Protective gear #PPE, BIG companies have been medication hoarding, and offshoring supplies and drugs to China and other countries.

Three years ago when we opened up Practicing Physicians of America (PPA) at the Library of Congress, who knew that our band: Westby G. Fisher, Niran Al-Agba, Brian Jamal Dixon, Judith Thompson and Myself would be on the front lines of COVID19? https://practicingphysician.org/

Who knew that after writing the Free2Care White Paper Last year, the changes we (Myself, David Balat, Kimberly Legg Corba, Doc Nikki Johnson, Caren Gallaher, Twila Brase, Kris Held, Craig M. Wax, Robert Campbell and others suggested to multiple Senators, Congresspeople and other policy makers, would present themselves as being necessary to happen so now and for the next epidemic, medical care workers aren’t fighting a virus without gear and tests, and we, the #scrubs are leading and NOT the suits in the C suites.

PPA became a member group of the Free 2 Care Coalition http://free2care.org/ Free2Care is now 2 dozen groups, with now 3 million patients and 37,000 Physicians, about to expand to 60,000. We are aligned behind the ideas in our white paper, in the process of updating. The ideas that unite Free2 Care are patient centric, Physician/Patient relationship friendly, cost effective and non partisan. Paper can be accessed here: http://free2care.org/wp-content/uploads/2019/06/Free2care.pdf

Free2Care has invited collaboration for a year. Member groups include: Physicians4Patients (Caren Gallaher, Basia Jenkins, Doc Nikki Johnson) Physician Outlook (Marlene Smith ) Hope4Docs (Marnie McGrath) Physicians Working Together ( Doc K Jackson Christina Lang, Marie Jhin Lassila ) DPC Action (Kimberly Legg Corba, Katarina Lindley, Lee S. Gross, Josh Umbehr, Chad Savage) Association of Independent Doctors (Marni Jameson Carey) Patient Rights Advocate ( led by the late Great physician and Senator Dr Tom Coburn, who passed away today. May he, a tireless advocate and always a physician rest in Peace) AMAC (The late Dan Weber and his family, Andy Mangione Bob Carlestrom ) Patients Rising Now (Terry Merrill Wilcox) Citizens Health (John Chamberlain, Megan Janas, Brennen Hodge) The Job Creator’s Network, Physicians for Reform (C.L. Gray, Bev Gossage) Practicing Physicians of America, who is proud to be helped by Kenneth A. Fisher , Lia Huston, Mark Lopatin, Christina Dewey, Katherine Newland Barton, Roy Stoller, Susan M Hull, Mark Lopatin, Susan Brown, Holly Thacker, Rupali Chadha, Jessica Leigh, Mary Delila Tipton, Jamie Wells, Dana Corriel, Amaryllis Sanchez, Jayemzee Costello, Patricia Aronin Sherrill, Natalie Newman, Reese Tassey, Ed Gaines, Chris Sheeron, Phil Mandato, Christine L. Saba-Constantios, Phil Totonelly, Karladine Evelyn Graves, Meg Edison, Sheila A. Olive, Pastor Stephen Broden, Robert Arlett, K Kay Moody, John Radell, Amy Judice Townsend, Amy Zellers-Shrader, Joel Strom, Justice in Medicine, Joan Cullen, Sheila Page, Danae Powers, Michael DellaVecchia, Brian Sachs, Ayal Kaynan, Scott Hardeman, Robert Dean, Marcello Hochman, Marchelle, Gianni, Venu Julapalli, Holly Fritch, John Tomicki, and so so many more!!)

Free2Care Executive Director, David Balat does this PRO BONO, as do all of the PPA board, and almost all of the physicians in the Groups who participate including those mentioned above and more!!!

Invite your physician friends to join one of the Free2Care member groups, PPA is free. Patients can join Patients Rising or AMAC. Physicians can join PPA here: https://practicingphysician.org/join/

Together we have multiple connections to Senators, Congresspeople, HHS, CMS and the Administration, and among our member groups, we have been SHARING those connections. Just today, the Amazing Amy Mecozzi Cho, Daniel Choi, Jason Adler, and Julio Gonzalez were emailing a US Senator who immediately called CMS to 🔨 barriers to make sure patients get care and nurses and doctors were protected.

This is after a week of more physician heroes pulling bad Surprise Billing language out of the COVID bill (twice) and pulling language that restricts cost saving innovation models out of the COVID bill. Nothing like tweeting “Take the PORK out, Piggies” 🐷directly at multiple Senators. Take that!!!

Good citizen centric ideas belong to all of us. And congress, the president and EVERY elected official works FOR #WeThePeople!

no time to rest… #patientsfirst #takebackmedicine trust #scrubsNOTsuits first!

⌛️⏰Time is up!!

Happy National Physicians Week!! 🇺🇸💜❤️💗🇺🇸 and God Bless America!