Counting Down to 90 - Week 1559 - Working in the Trenches Should be Non-Negotiable for Every Healthcare Decision Maker

The Concept Explained

Counting Down to 90 - Week 1579

Why 1579

Bhavin's WritingsBhavin Jankharia

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This piece was triggered by Vinay Prasad’s recent article titled, “Blood, shit, piss and pus,” in which he writes and talks about how those who make decisions regarding healthcare policy have no clue what they are doing because they have never actually seen or treated sick patients.

Blood, shit, piss and pus

What we touch in the hospital and who we are

Sensible MedicineVinay Prasad

I have been saying this in multiple forums ever since my first tryst with the corporate world in 2007. Though I was part of a diagnostics company focused on pathology and radiology, most of the executives at all levels who I interacted with had no basic clue of what patient care was all about. Luckily, I had the power to strike down stupid decisions, but most doctors don’t have that luxury.

The rule is and should be, “No person working in healthcare, whether in a practice, or a company, a hospital, a corporate, a pharma, in insurance or in the Govt (health ministry, etc.) should be allowed to do so until they have spent at least 6 months interning in the emergency wards/casualty, operation theatres (OTs) and busy Govt and private hospital wards and OPDs.”

Once during a quarterly review, one of the suits got up and explained why revenues will peak in Maharashtra, Goa and Kerala between June to September because the monsoons will increase the incidence and prevalence of infections, which in turn will lead to increased demand for fever related blood tests. While forecasting to make sure a practice is geared to manage the loads is fine, his next statement was, “let’s raise the prices by 10% because anyway the patients will have no choice but to get these tests done”. 

There are “suits” who do not want a single patient complaint or complication in their hospitals and will question junior doctors (because they can’t really do anything to senior doctors who bring in the money) for any mistake or complication. The other day, a suburban hospital needed a splenic aspiration and biopsy and the radiologist refused to do so because of the likelihood of the patient bleeding. The physician wanted to send the patient to me in my private stand-alone center. I told him this made no sense…why would I do the procedure in my stand-alone private clinic, especially if the patient was high-risk, when it could easily be done in a hospital? How can any hospital refuse a procedure just because of risk, unless they do not have the expertise, which they did in this case? The reason was the fear of answering the “suits”, if the bleeding led to a splenectomy or worse, death. I told the referring doctor to give the radiologist the confidence that he had their back…he did that and everything worked out fine. 

If these “suits” had ever worked in a hospital, they would know that if you touch a patient, there is likely to be a complication and the issue is not whether or not it occurs, which it will, but how well it is handled and managed. 

A few years ago, a major hospital in SoBo ran out of gauze because one junior clerk in purchasing sat on the tenders, waiting for someone to lower the price even more. Patients had to go out to pharmacies for two days and purchase gauze on their own, until the issue was escalated to the owner of the hospital, who then placed an instant emergency order. If that stupid clerk had interned for even one day in an OT, he would have known how critical gauze is and would have never done something so idiotic.

If you haven’t seen a patient seriously ill, about to die, or been in an OT with a patient’s intestines shining below the OT lights…you don’t know. And you are not qualified to then take decisions that affect the diagnosis and management of these patients. 

In those 8 years in the corporate world, I learned one thing: never to be beholden to a suit who knows nothing about patient care and whose entire patient care knowledge base comes from management colleges, where the teachers also have never actually touched patients. It is like a blind person confidently leading other blind people over a cliff edge or lost tourists confidently giving directions to other lost tourists.

Which is also the problem with private equity (PE). PE is run by suits who only know how to invest and make money. Healthcare can make money, but there is a limited number of patients in the end who fall sick. Once that avenue including raising prices is exhausted, then comes the play of converting normal people into patients by finding disease during annual health check-ups (gallstones being a classic example) or changing the goalposts and converting normal people into pre-diabetics or borderline hypertensives and once that is exhausted, pushing people into care (eldercare, metabolic care, etc) of all kinds, with the final assumption that being disease-free is also a disease. For example, pregnancy has been converted into an illness that needs to be “treated”. Finally, after all this, and in parallel comes the “cutting corners”, with inferior, cheaper materials, fewer people, restriction of use of medicines and all kinds of so-called treatment pathways that restrict the doctors’ ability to treat patients well.

Saying No to Preventive Gallbladder Surgery for Silent Gallstones

You can say no if you are being pressurized to get gallbladder surgery done for a silent gallstone

AtmasvasthBhavin Jankharia

I am sure many of you reading this have many more examples of the harm non-doctors in positions of power in the healthcare industry can do…much of it comes from the fact that they have never ever actually seen a patient die or puke, or wallowed in their shit and piss as Vinay Prasad mentions. No amount of watching Gray’s Anatomy or gaining MHA and MBA degrees in fancy management colleges helps.

In an ideal world, only doctors would be healthcare managers and decision makers. But there aren’t enough doctors for this. The next non-ideal choice is of non-doctors who have studied some form of management…but they don’t really know. Hence, every decision-maker in healthcare should go through a “trial by fire” and work in the trenches and see death and disease before being allowed to take any decision that eventually affects the treatment of a patient.