I read an interesting piece this morning about a medical renegade who turned his back on one of the most powerful health care systems in the world. It's not easy to push back against a leviathan. If I give you an oar, I doubt that you could change the direction of a cruise ship. But sometimes, a single person can make a wall fall down. Remember, the brave Chinese man who faced down an approaching tank in Tiananmen Square, which was captured on an iconic video? On a lesser scale, an orthopedist, formerly employed by The Cleveland Clinic Foundation, decided that his Clinic bosses were preventing him from offering his patient's the best medical care possible. He fired them.
The Clinic, in a cost cutting move, restricted orthopedists to using artificial joints from only two device companies. The surgeon had been using artificial joints from another company for nearly 3 decades, and he reported excellent results. This orthopedic surgeon had a bone to pick with his bosses, but their edict was as rigid as a steely plaster cast. There would be no exceptions.
Usually, when stuff like this becomes public, we are greeted by nauseating and sanitized statements from the PR office that generally seek to distract and deflect. That's when the PR Prism is so useful. Consider some examples.
Facts: A sneaker company is discovered to be using child laborers in Southeast Asia for 10 years.
PR Prism: Our company never knowingly hires underage works and always strives to adhere to the highest corporate ethical standards. We have started a full investigation and promise transparency and accountability.
Translation: We got caught.
Facts: A presidential candidate deletes tens of thousands of e-mails that were housed on a personal server that was kept in her basement.
PR Prism: I never violated my well known stratospheric standards for probity and integrity. To the best of my recollection, I never knowingly sent or received any e-mails that any reasonable Secretary of State would have regarded as Confidential, Top Secret or even Semi-Secret in accordance with written Policies and Procedures. I wish I could share these P & P manuals with you, but of course, they are classified.
Translation: Ha! Ha! Ha!
In what I suspect was PR lapse, the statements from The Cleveland Clinic contained some glimmers of actual truth. I would have expected some doublespeak about how the Clinic is ‘always striving to provide World Class Care…”, but here's what the Chief of Staff said after acknowledging that their corporate and coercive decisions can give individual practitioners vexing choices
“It doesn't make everyone happy. There is a tremendous amount of change going on in health care as we work to drive quality, but do it in a more affordable way.”
I congratulate the Clinic on at least admitting that they trying to save money, and not disguising the cost-cutting under the veil of medical quality. I support practicing cost-effective medicine, as I have expressed repeatedly in this blog. However, I suspect there is an important part of this story that was not reported in 9/10/15 Cleveland Plain Dealer article.
How did these 2 orthopedic device companies get the Cleveland Clinic gig? Was it based on cost? Did the Clinic or any of their physicians have financial ties to the companies? While the Clinic claims that physicians had input into the choices of these two vendors, was the process in truth a preordained corporate decision? Did artificial joint competitors have a fair shot to bid for the business? If a competitor sold artificial joints to a Clinic competitor, would this company be shut out?
This issue goes well beyond artificial joints. Every hospital in the nation makes deals for artificial joints, heart valves, intravenous catheters, medications, surgical instruments and radiology equipment. Increasingly, these are as much business decisions as they are medical decisions. If a product or service can be delivered more cheaply with no loss of quality, than we all support it. Who do patients trust to make these judgments? Your doctor or the hospital's accounting department?
I'm not suggesting that the Clinic, or the hospitals where I practice are crooked. But, the medical industrial complex has many tense conflicts of interests that are sequestered far beyond the view of the public. I'm sure there are troves of hospital e-mails that would be fascinating to review, unless the servers have been wiped clean.
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.