Paul Janson, MD, is to be congratulated for his thoughtful viewpoint, “Practicing Business Leaves You with Business.” (EMN
Dr. Janson remains hopeful that physicians are still able to get ahead of the progressive commoditization of health care, but I am less optimistic. Indeed, my sense is that physicians have largely abrogated their fiduciary responsibility to do what is best for their patients rather than to do what is best for themselves and for their taskmasters — hospital administrators.
Lifestyle choices that include maintaining an ideal body weight, not smoking, regular daily exercise, avoiding intoxicating substances in excess, childhood immunization, and prenatal care will go the farthest toward improving public health. Barring these, emergency physicians are faced with the realities of the bottom of the societal birdcage. EPs are the stewards of a vast resource of medical care and technologies, but these practitioners’ task is Sisyphean when faced with onerous oversight, unfunded mandates like electronic health records and computer physician order entry, Orwellian tort law, and scientifically unsupportable “clinical benchmarks.”
The unchecked proliferation of hospital administrators and CFOs and their clout (and their handsome salaries) is in inverse proportion to the autonomy, the respectability, and, indeed, the preeminence of physicians in health care.
Judging from America’s poor performance in public health metrics despite throwing an unsustainable percentage of its GDP at the challenge, our predicament is deeply concerning if not alarming. Regardless, congratulations to Dr. Janson, whose 40 years of service is part of the solution.
David M. Lemonick, MD