Have Physicians Lost Their MoJo?

Medical decision-making is a complex process, poorly understood by non-physicians, and often judged inaccurately by non peers. 

In today’s world changes are gradually occuring which erode physician confidence, and in some cases impinge upon moral and/or ethical decisions.

Twenty years ago we rarely heard of ‘disruptive physicians’ although I am sure there were many.  At that time it was politically incorrect to point out or collar the “offensive physician”, and the ‘whistle blower’ would face further embarassment or even official reprimands.

Medical decision-making is a complex process, poorly understood by non-physicians, and often judged inaccurately by non peers. 

In today’s world changes are gradually occuring which erode physician confidence, and in some cases impinge upon moral and/or ethical decisions.

Twenty years ago we rarely heard of ‘disruptive physicians’ although I am sure there were many.  At that time it was politically incorrect to point out or collar the “offensive physician”, and the ‘whistle blower’ would face further embarassment or even official reprimands.

Medical trainees today are taught to be polite to handle conflict and ‘insubordination’. Certain behavior in an academic medical center may not be acceptable in the ‘real world.’

Certain enlightened academic department heads can deal effectively with their trainees. Community hospitals should have in place process on dealing with disruptive physicians to remediate disruption and also to be certain that prohibited substances, alcohol or misappropriation of prescription medications are not a factor.

Physicians often see problems at their workplaces relating to patient quality of care, financial practices, mistreatment of staff, and other issues. But as more doctors take jobs as employees of hospitals, medical groups, and other large organizations, they increasingly face the same dilemmas as millions of other working stiffs. 

Across the country, a growing number of physicians are indeed losing their jobs — and often their hospital staff privileges — after protesting employment conditions. Such complaints may involve patient quality-of-care problems, short staffing, misallocation of funds, improper financial incentives, fraud and abuse, discrimination, overuse or withholding of medical services, or other misconduct.

When they come across actions or policies that they don’t think are right, they have to decide whether it’s worth it to speak out and get labeled as a troublemaker — or perhaps even get fired.

Physicians should communicate their concerns to their employers as professionally and objectively as possible through official channels, such as their medical staff organization or medical group, experts say. But physicians sometimes don’t take the ideal approach and risk getting labeled as disruptive personalities or troublemakers.

The employer (group) holds the upper hand and when the provider signs a contract the physician should realize that fact.

The AMA statement explicitly accepts that physician employment contracts may allow hospitals to strip doctors of their medical staff membership and clinical privileges at the same time they are terminated, known as a “clean sweep” clause. “If that’s accepted by the AMA, the rest of the principles protecting physicians are meaningless,” he argues. “If physicians can be fired without cause and then automatically lose their medical staff membership and its due process protection, how many will dare be a patient advocate?”

Some experts advise physicians not to sign employment agreements with such onerous provisions. But others say that physicians often have little leverage to remove them. “It’s not an equal negotiating table,” says Dr. Gatrell, who’s now working for a small urgent care practice.

Attorneys who represent physicians in such cases say that doctors need to think hard before they do stand up. Massachusetts attorney Peter Noone represents Veterans Administration staff physician Anil Parikh, MD, who was fired in 2007 after he disclosed confidential patient information to members of Congress out of concern over what he viewed as poor-quality care at the Jesse Brown VA Medical Center in Chicago. Dr. Parikh won a 2011 decision by the federal Merit Systems Protection Board that reinstated him on the basis of the federal Whistleblower Protection Act.

And that reminds me what my father told me, a long time ago: ”Life is not fair.”