PART 1 (of 5)
I once had a patient who was quite disappointed to hear that there were politics in medicine. I gently chided her that where there was big money, so came the political fights. This conversation reminded me of how sad I was when I encountered it in my first year of medical school. To say that it came as a shock to me then would be a massive understatement. Having no prior experiences to draw upon before embarking on my medical career, I had always been imbued with a sense of honor and higher purpose that I believed was the hallmark of the calling to serve in this capacity. Imagine my shock and dismay when I discovered that this was not how a fair portion of my classmates approached their schooling. Obviously I figured out a way to deal with my disappointment and channel it into something bigger and better. However, the politics remain and is ever present.
When I was a new graduate, medical professionals were segregated into well-established categories. There were the Primary Care doctors who took care of you and your family in sickness and in health in the office and in the hospital. Once you needed care beyond what they could provide, you went to the appropriate specialist and if you needed surgery, well there were the Surgeons of course. Once you set foot in the hospital, there were some specialists that you only ever encountered there, like the Radiologists, the ER doc and the Critical Care experts. Nurses staffed every unit and often had equally specialized training to match. For instance, there were Critical Care nurses, Cardiac nurses, Dialysis nurses, and so on. The more specialized the nursing unit, the more experienced the nurse, in general.
Now days, the Primary Care doctors have stopped going to hospitals and if you get admitted, you are taken care of by a “Hospitalist.” Your admission is tracked by insurance companies to ensure that you meet their criteria for your stay. While this has always been true, hospital administration getting involved in your stay has been a relative newcomer to the mix. Why would the administration care about your stay you ask? It’s all about the money of course and this is where the politics come into play.