Who Should Run Hospitals?

S. Q. Lapius was tinkering again.  He was dipping slides of blood stains into tall Coplin jars, adding liquid dyes, discarding the results and repeating the procedure with new batches of the violet liquid to which small quanta of reddish powders were added. His fingers were stained the various hues of a garbled color television. 

“It’s all been done before.  You can buy the stains,” I said. 

“Not really,” he answered, without looking up.  “You used to be able to buy the dyes, but since modern chemistry has refined them, certain ingredients have been removed in the purification process which brightened and added resolution to the blood cells.” 

“In an age of Coulter counters, electron microscopes, image intensifiers and immune-florescent techniques, why do you persist in fooling with the tools of the late 19^th century?” I asked. 

“For one thing, I can afford the tools of the 19^th century.  For another, I happen to like seeing perfectly stained blood cells.” 

Lapius never minded chatting when he was porridging with his staining powders, so I called his attention to the latest flap about who is running the hospitals.  Lately, the news had been full of disputes between doctors and governing boards.  As a matter of fact, some administrations were dictating the by-laws of the medical staff. 

“What do you think, Lapius?” I asked. 

“Beautiful,” he said, peering at his latest creation through the microscope.  “Slightly heavy on the blues, but that can be corrected.” 

“Not the stain, Lapius, the hospitals.  Who should run them?” 

“Harry, for goodness sake, stop needling me.  How do I know who should run the hospitals.  The government contributed Hill-Burton funds to build most of the hospitals, so they set certain standards.

“Because consumerism is the mode today, the architecture conforms to polls of what patients think will be most comfortable for them. 

“Because the insurance plans are complaining about costs, rules are established regarding length of hospital stay and facility duplication based on the fear that, if there are empty beds, medical costs will increase, the government won’t get its money’s worth from investment, and hospitals will go broke. 

“The market in patient care has been removed or at least painfully restricted.  The management of the hospital is vested in the board of trustees whose job is to confirm to the myriad laws and codes imposed at county, state and federal levels. 

“The administrator runs the place for the board of trustees.  So you tell me - who runs the hospitals?  Clearly unanswerable.” 

“Well, someone is going to have to answer that question.  There is trouble brewing, and questions of medical staff rights are being taken to court.” 

“How interesting.” 

“I thought that would intrigue you, Simon.” 

“Yes.  Come have a look.  The neutrophilic granules are developing a deeper hue.” 

I bestirred myself and walked over to the microscope. 

“Beautiful, aren’t they?” 

“They look fuzzy to me,” I said.  Lapius was pained. 

“Too bad they look fuzzy, Harry.  Medical matters must be seen by doctors with the finest clarity.  I stain these cells to remind me of that fact.  Hospitals look fuzzy to me.  There will come a time when all medicine will have a blurred appearance because soothsayers in high office, empowered to dictate through either law or monetary persuasion are trying to confuse the practice of medicine with the distribution of health care, and determining from afar the conditions that will meet the needs of the individual patients.

“We are entering a period of herd medicine which might better be practiced by veterinarians of the prairie lands.  Community needs are compressed into statistical parameters and run through computers to establish rules by which medicine will be practiced.  The physician insists, when he treats a patient, all influences other than those directly affecting his patient must be excluded.  He is therefore being shunted aside.

“Looks bad, doesn’t it.  Doctors are reacting by forming unions and other similar groups.” 

“Waste of time,” said Lapius.  “The doctor should make the hospital in which he works his major concern.  He should keep book on the hospital.  Note every order that isn’t carried out, every malfeasance of omission or commission that occurs in any of his patients.  He should record all medications withheld, given in error, all orders confused, all instances when supplies are inadequate and in fact monitor the ecology of the hospital as it affects his patients. 

“He should compile these matters and offer them monthly to the administrator with copies to the board of trustees so they will know what is going on.  If the matters and systems aren’t corrected, the file should be turned over to the inspection teams that accredit the hospital.” 

“That’s wild, Simon.  A medical staff threatening the accreditation of its own hospital.  Not only that, its blackmail.” 

“No more blackmail than Blue Cross or Medicare refusing to pay the hospital for what they might consider an extensive utilization by a patient.  No more blackmail than for Medicare or Blue Cross to insist on certain money-saving procedures or threaten to cut the hospital from its reimbursements.  Of course, when Blue Cross and the government, through Medicare, prevent a hospital from putting in necessary equipment for fear of reduplication in a community, that is not called blackmail, it is called fiscal responsibility.  But a Blue by any other name –.” 

“You don’t expect medical staffs to take that risk.  The risk will cut off their noses to spite their faces.” 

“They might as well.  Their noses are being cut off anyway.  The doctor has to be an ombudsman for his patient and take his chances.  Call it blackmail if you will, but I don’t believe any administration will call them on it.  It would be much easier to respond to constructive criticism.  After all, if the hospital loses accreditation, it simply shows the board hasn’t been doing its job.  What other way is there to show that.” 

“I guess your stains wouldn’t show that, would they?” 

“No, not that.”