Thread by @usnehal

Normalize reporting that is non-punitive. There may be some reporting that leads to a dismissal but good systems do a fish one or RCA to identify system factors and processes or staffing levels before blaming anyone individual.

https://twitter.com/agnessolberg/status/1330561689394302976

Now that the majority of physicians are employed, there is an imbalance of power between administrators eyeing hospital margins and their main revenue producers, docs. With expanded scope of practice then it is “providers” who bill. All are employed/controlled/kept in line.

In the past (there was a LOT wrong in the past albeit) there was a balance of power. Hospitals needed doctors to admit to them, refer to them, do procedures there, see their patients there. Docs needed hospital facilities for inpatient or surgeries. Now, that mostly is erased

Nursing & all non-clinical staff got short end of the stick in the past. Unions protected nursing rights as employed staff but the bully doctor who might throw a scalpel across the room was untouchable.

Only today’s “disruptive doc” is speaking up on PPE bloomberg.com/news/articles/…

I am all for workers rights. But these types of issues have not aged well when we have had providers who have gone to court to protect right to not wear PPE or standard safety measures as a workers rights issue. precisionvaccinations.com/nurses-ontario…

Personally, (may sound hard to believe) but cuz I did wear masks at work pre-COVID (I worked in both urgent care & newborn and did not want to carry RSV or such between two settings) I got bullied as if I were a strike breaker for compliance (vs this suit) hstoday.us/channels/feder…

I have tremendous respect for nurses. Am only as good a doc as the nurse I work with. How many times have nurses been the reason the right thing gets ordered or the wrong order is questioned?

So it really pains me that in recent years politics is disrupting team trust & safety.

Was asked today by a military special ops guy (been in some of the most critical situations for global security) my opinion on when this will end. I had very little hope to offer him given high rates of provider vaccine refusal

Vaccines only work if used
bostonglobe.com/metro/2019/12/…

Providers are the ones, particularly certain unions, who provided legal rationale & legal precedent used by increasingly number of lawsuits vs businesses for mandatory masks. “You can’t infringe on my personal rights to save lives (with public health).”

theverge.com/2020/7/13/2131…

Safety is extremely important. Seeing what was happening to PPE, seeing the miscommunication between feds, state, city, hospitals, I turned down a NYC CMO job in early 2020

These nurses are right
Also true is just not enuf PPE

How to care for patients?

politico.com/states/new-yor…

I don’t know what the right decision was ethically. Do you take a leadership role where you tell clinicians “just wear a bandana” per then CDC? Do you keep yourself pure/pristine & step out of the arena, not accepting leadership because only choices are bad or worse?

Unions have fought some really important battles & are critical for low-in-hierarchy workers at risk for retaliatory discipline or termination.

Docs, previously independent, tended to act solo + have been carried almost all legal risk of the team.

wkw.com/medical-malpra…

Now that doctors are employed but not unionized & still carry most of the liability, balance disrupted

the “disruptive doc” label
is used opportunistically

vs truth telling about employer conditions that affect safety & quality

Misused label is most effective vs BIPOC & women

I see a lot of WOC physicians leaving for these combinations of reasons. Professionalism policing out of “disruptive doc” protects institutions, not patient safety or quality. Very tough choice to chose between self preservation vs staying to counter this nature.com/articles/d4158…

Between individual effort/excellence vs the system, the system will win/beat you (down) every time per systems and quality expert. Does one self harm, be harmed, and/or be party to harm with these statistics of what impact personal excellence has in outcomes? Marginal gain only.

Gender or race aside this is already what is written about #healthcare like @EricTopol medscape.com/viewarticle/92…

Betray is a strong word

“expose to danger by treacherously giving information to an enemy”

Is a word that speaks of lack of values, honor, ethics

When an industry (yes, industry) has all the wrong incentives and outcomes then it NEEDS disruption. The AHA publishes this but its member institutions would be wise to listen to truth tellers within who are Cassandras - not crazy but aware of trends aha.org/disruptive-inn…

Anyone who follows me knows I am full of criticism of my own profession. We need reform & reformers

Right now who is protected (or ppl look away from) is the revenue producers affiliated with industry like Wakefield was

Industry not bad but needs careful COI reporting

https://twitter.com/usnehal/status/1328165236592013312

Now that private equity in charge, we really have to stop these mottos of which clinician type is the one with heart or is the caring advocate vs the “disruptive doc”

you need the outspoken doc who will not wait for union protection before disagreeing

healthaffairs.org/doi/full/10.13…

This is what I am talking about

It is the new boss and there is a very different mindset of valuation, monetizing, operational efficiency, assets, cost control, staffing models, replacements, pricing, access, etc.

This is what I mean. When a banker buys an historic hospital serving the inner city & underserved, calls it quits within 1-2 years, and sells off the pieces, human beings, doctors in training, are sold as well, meaning residency slots at the hospital whyy.org/articles/bankr…

Residency program or hospital equipment? Same, same. All are assets for sale. This is a new era in healthcare and one where it being an industry, previously opaque and cloaked in academic language, is more and more transparent and obvious

bizjournals.com/philadelphia/n…

“Well below market price” in a pandemic vs duty to care

“nearly 500 beds has been closed for months..bracing..crush of sick patients...cannot accept..offer: buy the hospital or lease it for almost $1 million a month, including utilities and other costs”

nytimes.com/2020/03/27/us/…

The healthcare turf wars are exactly what new competition minded & ROI to shareholders types love. Find cheaper replacements and drive down a main component of operating costs, payroll/salary. Get employees to compete with each other.

Labels by clinician type feed into this.

Not employed by any hospital this year & a full time student, I am calling a spade a spade.

We have system failure, industry failure, institutional failure, and with the burden of filling gaps put onto individuals, then we force individuals/workers into failure as well.

https://twitter.com/halos_systems/status/1290684012747460613

Full #podcast with @Ned_Arick

If an industry
has failed
has wrong incentives
operates by a failed, low quality business model
resists change
penalizes truth tellers

One could advocate or reform
Tried that

I choose:
Hack
Disrupt

(“Disruptive doc”?)

anchor.fm/the-state-of-h…

@threadreaderapp please unroll