The Critical Eye

Rick Johnson, for HealthLeaders News , September 6, 2007

Life as an editor can lead one to become at times overly critical--and perhaps even cynical. A prime example: The column I wrote two weeks ago called Hair Today, Gone Tomorrow. In it I listed the top things that make physician leaders want to pull out their hair.

I attempted to keep the list humorous, but a couple of readers pointed out that there are alternative positions to a few of the items. Life as an editor also goes much smoother if you learn to appreciate well-considered and constructive feedback.

And I do.

For instance, this reader offered another view of case managers that is much richer than simply "bean counters":

    I won't add to your list, just comment on the first item from the perspective of a physician leader who works closely with our coordinated care nurses/case managers. I'm sure there are some who act simply as "bean counters to make money for the hospital." However, ours combine utilization review with discharge planning and quality improvement activities--and have come to be appreciated by wise doctors as valuable members of the care team.
    They often discuss preferences/requests with patients and families when doctors have neglected to inquire; they monitor performance of publicly reported Medicare core measures (sometimes aggravating a physician by asking whether he/she has considered aspirin after an MI); they make sure patients have been asked about advance directives. And yes, they do try to make sure the hospital gets paid by pushing to expedite inpatient testing or nudging doctors to make decisions when a patient no longer meets hospital level-of-care criteria.
    Unfortunately, payers have policies that do not lead to hospital-physician alignment. Doctors--the only ones who can write a discharge order--often continue to be reimbursed for care even if the insurer is denying hospital payment as unnecessary. Thus, many payers have set up antagonistic relations between physicians and hospitals. Case managers need to have good clinical judgment and skills of persuasion to reconcile conflicting interests. Of course, a consistent and transparent payment system, rewarding cost and quality achievements--for all private and governmental insurers and providers--would go a long way toward solving this problem.
    Paul F. McKenney, MD
    Associate VP, Medical Affairs
    Kent Hospital
    Warwick, R.I.
And this reader forwarded the thought that my top five list was not exclusive to healthcare's physician leaders:
    As a proprietary hospital CEO, I completely concur with your listing of the "five things that make physician leaders want to pull out their hair," with one caveat. For your consideration, I would like to put forth the hypothesis that these frustrations not only plague the physician leader, but the non-physician healthcare leader as well.
    Twenty years ago (when my hair was brown and not gray), I determined that my career path would be in healthcare administration. I wanted to be the manager of the tools through which physicians provide the optimal in medical care (a bit pie-in-the-sky, but I believed, and still believe, that I could make a difference). I have always been proud to consider myself a "professional healthcare executive." The same issues that frustrate my physician colleagues drive me nuts as well! I work 24/7 in an attempt to remove these frustrations (or at least minimize them). I firmly believe if I do my job effectively, in partnership with the physicians, not only will the frustrations be removed, but the patient will also receive better care.
    To this end I would like to suggest that we must work more toward partnership (shared vision and respect) between the physician community and the non-physician healthcare executive community, replacing our respective "lists of frustrations" with a "list of opportunities to benefit our patients."
    Who knows? Maybe in the end we can both save some money in razors (to remove the stubble from pulling our hair out) and Grecian Formula (to hide the gray).
    David W. Fuller, MBA, FACHE
    Chief Executive Officer
    Woodland Medical Center
    Cullman, AL
So for others in the industry reading my weekly columns, feel free to take the lead of these readers and keep me in check from time to time. I won't mind a bit. In fact, I can sympathize with others who go through life with a critical eye.
Rick Johnson is a senior editor with HealthLeaders Media. He can be reached at

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