Is it Schadenfreude?

How much do government and bureaucracy hate us?

It’s been a while, and for that, I apologize. Clinically very busy, and basically trying to swim upstream in the medical administrative nightmare analogous to the Cuyahoga River in June 1969…

https://www.history.com/news/epa-earth-day-cleveland-cuyahoga-river-fire-clean-water-act

That debacle in Cleveland led to the creation of another bloated, overbearing government agency, the EPA. Let’s hope the current chaotic maelstrom that is American healthcare doesn’t lead to MOAR government. It’s not as if we don’t have enough…but, you and I both know that the usual answer to inefficient, unwieldy and unworkable is often more of the same.

I have to be honest, it’s becoming difficult to press on. After months of badgering, browbeating and, embarrassingly, pleading with my tiny hospital's CEO to come spend a day with us in surgery, watching us employ a technology that I fought to obtain for a decade (and, to their credit, that the CEO helped usher through the archaic,byzantine Certificate of Need process) and that no other nonacademic facility in our state is in possession of (we were first and use it to patients’ benefit more than almost any facility in the nation), I had to show the CEO where to find scrubs. C'mon, it’s a 40-bed facility with 5 operating rooms, how hard could it be? After 30 minutes, no CEO, better things to do. On the fourth of six cases, our unit malfunctioned. After 19 months and over 200 cases, I guess it wasn’t a surprise. Technology DOES periodically fail. After an hour of online diagnostics and via telephone with Germany, the manufacturer's base, we shut down, closed the patient and called the ball. Tumor was resected, but no radiation delivered; an internal control console failure. No parts in the US, must be overnighted from Baden-Wurttemberg. Sent two patients home, both were (thankfully) understanding. Live to fight another day.

This morning, I find out, quite surreptitiously, that the hospital experienced a power surge about the time things went sideways, which puts responsibility for repair on US (or our insurance). CEO had no knowledge of it. Going to “drill down”, I suppose. Embarrassing that I heard about it from the patient’s husband whose plugged-in laptop got fried simultaneously.

What’s wrong with all of this? It’s pretty simple; no one's on top of everything. Of course someone should be. Surge protection? Too simple, though the entire facility should be adequately protected. The unit in question costs $600,000. Other expensive equipment equipment abounds… surgical robots, tomography units as examples.

This is not limited to my little facility. This is modern American Healthcare. Not enough people, struggling equipment and physical plant, and the IDGAF Mentality. You know, I don’t give a f$%&. It’s pace of expansion is rampant. Administration hostile to both providers and their patients, massive amounts of computer “paperwork” (overwhelming, really, with no reduction in use of reams and reams of printer paper), angry/anxious patients, uncertainty about the future….yeah, living the dream.

I’m pretty busy. Stupidly busy, actually, 99th percentile volume and corporate will let me run til I drop, then find a warm body to replace my rotting corpse. That hit me this morning, rather profoundly. I’m approaching the limits of physical, mental and emotional exhaustion. Several colleagues around the country feel the same way. Private practice is a dead man walking, collecting 30% of billings and with practice overhead skyrocketing. There is nowhere else to go. No hidden nirvana. Not-for-profits hide behind their status yet generally are more vicious and uncompromising than their for-profit competitors. It's that Humanitarian Concern, you know.

I love what I do. The satisfaction of patient care, successful surgical outcomes, improving techniques and teaching them….there's nothing like it. No one, despite what those of you who think we practice our craft to “get rich” may believe, does this for money. The money is an accoutrement, lagniappe. Ask my wife, she’ll affirm that she shares me with my work, often at a disadvantage. I heard this song for the first time this morning. It’s about a relationship, but that's what doing this job is, medicine is my jealous mistrss, and she's on the rocks …

https://youtu.be/tCgBBICkPuY

In all this desperation I fear there's nothing I could say
To win this fight
'Cause you hesitate much more than I could ever estimate
And that's alright
'Cause I'm not insane, I'm only a fool for you
But I couldn't stay away, yeah even if I wanted to
So what am I supposed to do

You don't have to be the one to lose
You don't have to be the one to tell a lie
You don't have to be the one to choose
You don't have to be the one to say goodbye
And I don't have to bе the one to take all this
Timе you've wasted being dishonest
But I will not be the one who never got the chance to change your mind

So what's the point of this random free association? I’ll get it down to one short statement. Health care in America is f$%&ed. Get over it, avoid interacting with it, and, as I’ve blogged before, don’t get sick. I don’t see a way forward without radical change.

More to come