One of the most-quoted “Simone’s Maxims” (from a 1999 article in Clinical Cancer Research) is that “institutions don’t love you back.” Well, they may not love you, but they are increasingly paying attention to you. Healthcare systems want to know how you feel and what you’re saying—even outside of work. Is this intrusion into employees’ personal lives meant to improve morale or police dissent?
I’ve recently written two essays exploring the relationship between individuals and healthcare systems. The first asks how employers can tackle the problem of employee “wellness.” The second asks whether hospitals have a right to discipline doctors for outré political views.
Mergers and afflictions: can wellness soothe the healthcare beast? in the Journal of Clinical Pathology:
The physical and psychic burdens of working within this system have thankfully become an acceptable topic of conversation. Employers openly acknowledge the epidemic of burnout—meaning ‘overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment’. The flipside of reducing stigma, however, is normalising suffering. The website Medscape publishes an annual ‘physician burnout and depression report’, which flattens the profession’s distress into aloof pie charts and bar graphs. The National Institute for Occupational Safety and Health recently launched a campaign to support hospital leaders in combating burnout. Staff can perhaps look forward to completing mandatory burnout training after they have finished their blood-borne pathogens course and N95 mask fitting.
Employers, of course, profess to care about worker well-being. Formal initiatives abound. But the quality of mercy is often contingent on the quality of balance sheets. Among the worst epithets that get thrown around in healthcare is the accusation that one’s department is a ‘cost centre’. This means that the department loses money despite the essential services it provides. Clinical laboratories’ fortunes have waxed and waned over the years. Their value has depended on test menus and volume, payer mix and the whims of the Medicare fee schedule. During the worst of the COVID-19 pandemic, labs saw much of their routine work diminished, but could bolster their bottom lines with SARS-CoV-2 assays. As millions of people sought out COVID-19 tests, laboratory technologists briefly became respected front-line heroes. Now they are back to simply being ‘the lab’, and fiscal gravity has kicked back in.
Ousting doctors for bad opinions is bad medicine in the Boston Globe:
Medicine brought this problem to its own door. The profession spent the Trump and pandemic years encouraging doctors to speak out under the auspices of patient advocacy. The argument went that medicine and public health are inherently political; therefore, openly engaging in political action is the honest approach. This mandate, however, was always contingent on having shared politics.
Here is a pdf copy available to all.
Thanks for reading,
Ben
My personal litmus test for if/when doctors should be disciplined for espousing radical views is when they advocate for things that could have a direct health impact and are well outside the accepted mainstream medical consensus. For example, someone may be a brilliant neurosurgeon, but if they spend their free time spreading misinformation like vaccines cause autism, that would be fair game. I am personally shocked that physicians like Vinay Prasad and Jay Bhattacharya that signed the Great Barrington Declaration and have only gone further down the conspiracy theory and quackery rabbit hole retain their faculty positions at prestigious institutions.
On the topic of purely political speech, I am inclined to agree healthcare providers should not be punished for espousing personal beliefs that I find objectionable. For one example, early in 2020, I was seeing a cardiologist in Tampa for a work-up of sudden onset palpitations. This MD spent the entirety of my stress test ranting about liberal plots to take down Trump (the combined effect of the treadmill and his political speech certainly pushed my heart to its limit!) I politely finished my appointment and never returned for follow-up. I don't think he should be fired or anything dramatic, although their conduct was certainly unprofessional and IMO crossed a line. Luckily there are a number of specialists in my area, but people in more rural areas may not have the luxury of shopping around if they're stuck with a doc like that one.