I was fortunate in my medical training to meet many bright, talented and dedicated physicians.  One man that sticks out was a pulmonologist in private practice with whom I spent 2 months.  His practice was the stuff legends are made of.  The kind of medical practice that when described to younger physicians today, most don’t believe what they are hearing.  This man was busy.  He often had over one hundred patients in the hospital.  It was not uncommon for half of them to be in the intensive care unit on the ventilator.  He would makes rounds twice a day with his very busy clinic in between.  He was consulted by other physicians in the hospital about other patients in the hospital.  After admitting four or five new patients and consulting on another five or six, he would sit down and call the dictation service and deliver the most detailed and accurate history and physical information on each of the new patients by memory.  No notes.  Keep in mind that these patients were not healthy folks.  They had complicated medical histories and were on multiple medications.  To this day, I honestly don’t know how he kept it all straight. 

He was demanding.  He accepted no less than the best from everyone involved in his patients’ care.  I saw him on more than a few occasions tell a head nurse or an administrator that nurse “X” would no longer be allowed to take care of any of his patients.  He would then give a detailed, unemotional account of how the patient had been put in jeopardy by this nurse’s incompetence or laziness not only on this particular occasion but in the past, as well.  Detailed.  The hospital was on notice.  Make sure that this doctor’s patients got the best care.  He tolerated nothing else.  This forced the hospital to make some tough personnel decisions over the years.  If they did not keep up their end of the care bargain, this doctor and his massive practice would vaporize.  Go to another hospital.  In many ways, this physician was the customer of the hospital as he acted as his patient’s advocate and champion.

What’s the point of  all of this?  Doctors as hospital employees don’t have the leverage to make their employer (the hospital) keep their end of the care bargain.  Physician complaints have no teeth.  I cannot overstate the importance of this leverage in upholding quality of care. 

It’s the people thing again, huh?  This wonderful doctor taught me so many lessons.  One of the most lasting was his untiring and almost zealous advocacy for his patients when roadblocks to a good outcome raised their heads.  In many ways I have him to thank for abandoning the busy hospital practice I had and starting my own facility.  The physicians that work at our facility meet the highest quality and ethical standards.  The personnel are simply the best.  Great outcomes for patients is our mission.  The accountability of ownership of our facility brings our accountability to our patients to an even higher level. 

Keep this in mind if your physician or surgeon is a hospital employee.  They are simply hamstrung in their ability to do what’s right for you. 

G. Keith Smith, M.D.