The real choice is, of course, is your integrity worth so little that you'll cower in fear instead of go on your own?
Viewpoint
No Metric Bonus is Worth Your Soul
Mosley, Mark MD
Emergency Medicine News:
April 2020 - Volume 42 - Issue 4 - p 3-4
doi: 10.1097/01.EEM.0000660500.38396.0e
Metrics
Modern science-based medicine in America has been a profession with a moral ideology—altruism instead of advertising, science rather than selling, patients ahead of profit. Osler, Halsted, Mayo, DeBakey, and others created the profession of an American physician who was called to heal, a virtue that was highly valued.
There is a crisis in American medicine, a cultural shift in which the moral foundation is being restructured with market-based materials. An elite class of philanthropic professionals with unique and highly specialized skills are being replaced by a less expensive, amorphous group of “providers” employed by corporations to implement protocols to obtain better metrics and attract more health care “consumers.”
Employed providers are financially incentivized to obtain better metrics, further eroding medicine's altruistic base. The suits used to nod to the white coats, at least on patient care. Today, the suits develop ways to make the white coats bow. This is the dirty little secret—everyone is paying hush money.
Greed is not new to medicine or physicians; every historical medical oath cautioned against it. But we have never had a systematic shift in the way medicine is developed and practiced, in which research, journals, guidelines, colleges of medicine, government agencies, and protocols put in place in hospitals are all implicitly designed and executed to satisfy industry interests and maximize profits.
Even nonprofits look like for-profit medical entities.
These market-friendly forces do not simply co-exist neutrally alongside evidenced-based medicine; they increasingly change providers' behavior even when good science has proven the approach does more harm than good. No one endorses the vulgarity of harming patients for profit, but this is exactly what is happening, even if that is not the intention. And providers who use these profit-based protocols better are paid more.
Some physicians have acquiesced to this view or even embraced it by saying medicine is a business. No one would disagree that medicine must attend seriously to issues of financial responsibility. Like marriage, childrearing, a place of worship, or education, managing money is essential, but that is different from saying marriage is a business or religion is a business. The same goes for saying medicine is a business. The primary goal of a business is to increase profit. This is not the primary goal of marriage, religion, education, or medicine. These have aimed at a higher moral value, at least historically.
There are limits on what power we can have over the health insurance industry, the pharmaceutical business, medical device companies, corporate hospital systems, and even physician groups. We shake our heads when previously trusted entities like the American Heart Association, the National Institutes of Health, and the Centers for Disease Control and Prevention are tainted with significant conflicts of interest with a market-based industry. We seem paralyzed by the Centers for Medicare and Medicaid Services, which is predominantly a non-physician entity that repeatedly creates financial rules unsupported by good science and is even disavowed by reputable medical groups. STEMI, stroke, and sepsis protocols have become automatons that maximize profits for hospitals while patients are the collateral damage.
And then our jaws drop open when one of the bastions of doing the right science for patients (e.g., the Cochrane Collaboration) collapses under the weight of becoming more market-friendly.
This sacred profession has fallen asleep, having bitten the apple of corporate business. What are we to do? We can no longer remain silent and shrug our shoulders. We can no longer accept hush money. We must refuse the market-driven protocol that is not scientifically supported to benefit patients. We must find the courage to speak. It is our profession that is at stake. It is our duty, our calling to put patients first.
There is no metric bonus worth your soul.
Dr. Mosleyis an emergency physician in Wichita, KS.
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