Are these really the people that should be required to work so much? Isn’t their job about handling life and death daily? Wouldn’t we want exactly these people to come fully rested to work every single day and be fully staffed?
I don’t know if there are jobs with similar stakes that are so carelessly staffed and disgustingly paid.
A combination of a few things.
First, the founder of modern medical teaching was a man who loved cocaine and created a fairly aggressive education program which fed into a profession without work-life balance. The profession hasn’t self-reformed while cases where skilled labor has massive overtime is generally more regulated.
Second, the cost of education is enormous. Medical training for a doctor costs north of half a million dollars, so there is a high cost to training an additional doctor. Because of that, it is more cost effective to add additional shifts to existing doctors and nurses.
Third, a lot of doctors have a god complex and don’t want to admit they are fallible people. Because of this, they resist a lot of best practices other industries; checklists for operations are a 21st century “medical technology”. There isn’t a push within the industry to study how people fail like there is in other industries.
When I was an electronics technician in the Air Force, ‘tool accountability’ was huge. All toolboxes were arranged with individual foam cutouts for every individual tool, no matter how small, so it would be quickly and easily obvious from a mere glance if a tool was missing from the toolbox, leaving an empty cutout behind. (Like this.) Paperwork was required to check tools out of and into tool boxes. At the end of every job, the toolbox had to be checked – both the paperwork and visually – to ensure no tools were missing. (And if tools were missing, the job wasn’t done until those tools were found and accounted for.)
And that’s because aircraft in general – and jet engines in particular – really don’t like lost tools banging around loose inside. I didn’t even work on engines, or even on aircraft, but the Air Force had adopted these policies service-wide to prevent accidents resulting from lost tools left inside engines.
Which is why it baffles me that surgeons can sometimes accidentally leave a tool inside a patient. Working on a real human body is way more important than anything I worked on … and human bodies don’t like foreign objects left behind any more than jet engines do. Plus, those surgeons are getting paid so much more than I did, and they even have assistants in the room to handle the tools for them. How the fuck have they not managed to have a similar system of tool accountability, preventing them from leaving tools behind inside patients?
Surgeons are considered money makers in hospitals, literally “the talent.” If a surgeon punches a nurse, the nurse will be the one fired. If a surgeon sexually harasses a tech, even rapes a tech, the tech will be fired. If a surgeon makes life difficult for everyone in his department, they will work around him like a missing stair. If the surgeon comes in drunk or impaired, this “working around” gets tripled into direct coverup, where no one sees anything and no one knows anything. Reports are rote fabrications, as are incident reports; Joint Commission visits are scheduled in advance and prepared for (and their results kept non-public); when an incident occurs family members are routinely bullied; and god help you if you are an employee and you have a problem with any of this: whatever keeps the money coming.
Hospital HR departments are set up to maintain exactly this situation, to the point that even the internal complaint process is rigged, for example in a situation where per the employee handbook you as an employee must submit ALL your evidence up front, and no evidence added later will be considered. You might think, “Well, that’s harmless enough, right?” No. What this does is game any complaint from the start: you as an employee generally can’t sue successfully unless you have tried internal solutions first, and this way the hospital gets to see everything you have upfront, create a defense and/or coverup tailored to your proof, and then counter-accuse you with bullshit you cannot rebut because you never saw it coming and are not allowed to submit anything further. So you either have to sue, or accept being fired at some point, if you’re not fired outright with whatever fabricated misconduct you get charged with as a result of bringing the complaint. Or you can just drop it and try to get on with your career somewhere else.
I have more, but you get the idea. These true experiences come straight from a very large hospital in the southeast US, one that would be considered “award-winning” in a major combined metropolitan area and is considered a “great place to work” based on salary rates. But inside those walls, people who work there usually and very quietly go to the smaller hospital across town when they need their own surgical healthcare. There are many, many great people that work there who are every bit people you would want on your own healthcare team should you need it. But in many departments, the ones that demonstrably aren’t great are not the ones who get fired.
I’m sure other hospitals are better, but many are even worse. The very rare surgeon who does lose their job for cause anywhere in the US is out only because after a years-long road of internal complaints and related witness/complainant firings and employee harassment, one person, at great cost to their own career, doesn’t back down, OR by a stroke of circumstance a patient who is harmed has the right connections to make some kind of justice happen, and then the surgeon moves to another hospital in another state. But that’s rare.
And it’s all about the money: surgeons bring in lots of cash, like oncologists and cardiologists do, and elective surgeries bring in even more. Who pays for all that cushy hospital administration? Surgeons, specifically, among others. You’re 100% right that surgical mistakes can be eliminated, but not in a healthcare system that prioritizes profit over all else. If that surgeon has a pulse and can get to the hospital without getting arrested for DUI, guess who’s doing your surgery? Hospital HR departments protect “the talent,” simple as, and state licensing boards aren’t any guarantee either: they’re staffed with MDs who all went to the same schools as the people whose professional conduct they are entrusted with overseeing.
Solid post. #2 stings extra, extra hard when you learn that in the USA doctors spend on average somewhere between a quarter and half their time (studies vary) with insurance nonsense. We could potentially DOUBLE (or, low end, increase by 1/3 which is still insane) the number of useful doctor hours tomorrow, but we don’t. U$A
on the third point the it was the anesthiesa professional group which made the push for the much more rigorous process that greatly improved outcomes. So there is some precedence for the profession realizing it needs to improve processes.
Yes, and it is important that those doctors advocated for better patient care and that the desire to develop procedures are somewhat there. However, the medical profession as a whole seems to be less focused on procedures than others.