Is American Medicine Just a Big Market Failure?
31st August 2023
A few years ago, my daughter-in-law, an RN who left nursing for a better-paying administrative job in an expanding hospital conglomerate, almost quit when she was assigned to call doctors listed on a computer printout to tell them that they were spending too much time per patient and that was deemed unacceptably inefficient. Several told her that they were going to quit anyway because it was an intolerable setup.
My first legal job as a law student paralegal was doing document searches at NIH and the Library of Congress for medical malpractice litigators. (The world would not be online for another decade or so). I was hired in part because I had been a clinical lab tech in the Army and had worked nights at a local large hospital lab so I could navigate the material. Aside from a few cases involving really bad docs, it was surprising how much of a liability problem there was in information management and flow: Important things missed with disastrous results.
It seemed (seems?) as if MDs had to be dragged kicking and screaming into a far more integrated team approach in an increasingly complex environment. How do we encourage, liberate, and reward the best performers at every level and yet still make the quality of delivery uniformly better? I have seen firsthand that a change of shift from one set of nurses to a less gifted or less motivated crew is like night and day for service quality (and malpractice risk). The personal touch matters. A lot of medicine appears to remain a matter of intuition, empathy, art, and virtue, not just science. Are mega-corporate environments by nature hostile to that reality?