Medical Leadership Lacking

S.Q. Lapius was snorting like a porpoise.  “Why are you snorting like a porpoise?”  I asked him.

“That is a snort of indignation, Harry.  Here, read this letter I’ve just written to the editor of the Philadelphia Bulletin.  That should explain all.”  He handed me a rough copy. 

Dear Editor:

            Your editorial, Unsnarling Blue Cross (Sunday Bulletin, December 16, 1973), asks for intervention in the Blue Cross-Hospital negotiation, by a Mr. McNerney (National President of the American Hospital Association) and calls them respected “medical leaders”.  A medical leader, by definition, is called doctor, abbreviated Dr.    Mr. McNerney and Mr. McMahon may be leaders in the economics of medicine, or in the distribution of what is now called health care, or in the nebulous entity formalized now in the medical school curricula as community medicine, or the politics of the new health-industrial complex, but none of this qualifies them for the application “medical leader”. 

As a matter of fact, there is no medical leadership.  The AMA, rent as under by internal strife and defection from its ranks, has adopted a low profile after its invidious role in the debates preceding Medicare legislation.  Practicing physicians, singly, and in groups, are being steamrollered in the hospitals by the so-called medical leadership, which consists of non-medical boards, trustees and administrators.  Hospital costs are spiraling upwards because of this inept, statutory and strangling leadership.

For example, hospital architecture is inefficiently stylized by the promise of medicare and third party insurers to pay for semi-private accommodations.  (Semi-private is a misnomer, actually the rooms are semi-public.)  But from a medical point of view, the semi-private room has been a major cause of high hospital costs.  First, by stipulating no more than two beds to a room, hospitals are forced to sprawl over large tracts, instead of logical compression that wards would offer.  Patients are invisible to nurses who have to traverse miles of corridors to get their chores done.  Cleaning and heating bills are increased inordinately.  Patient care is inefficient, and must be supplemented by electronic surveillance devices.

For efficient care, hospitals have returned to the ward concept in creating coronary and intensive care units.  They do not even separate men and women in these ‘wards’.  In most there may not be toilet accommodations.  But the care is intensive, life-saving, and in general, excellent, since patients are under constant surveillance by a group of nurses stationed only a few feet away from the beds.

Of course the term ‘ward’ is opprobrious, bringing to mind as it does, the sloth of Philadelphia General, also run by so-called medical leaders, who happen to be non-medical trustees.  But a clever architect could design a much more efficient hospital plan that would offer adequate privacy within the confines of a ‘ward’ concept.  Of course, we would drop the word ‘ward’ altogether in exchange for ‘care’ unit which might be more palatable to the public.  But our medical ‘leaders’ could employ public relations experts to so disarm the public.  At present, the doctrine of semi-private accommodations has been so institutionalized that no board would dare submit a new design for fear of being turned down by the various authorities that govern hospital funding and construction.

I recall when I worked at a large Geriatric Center, pleading with administration to buy 10 (about $1,000 worth) of soft mattresses to protect patients from development of bedsores.  It takes about six months of daily medical and nursing labor to heal a deep bedsore in the elderly.

The administration couldn’t find the money which would have saved them hundreds of hours of nursing and medical care and laundering bills, a return of investment of about 1,000 per cent.

They hemmed and hawed and finally agreed to try some lease-purchase finagling with third parties, then shuffled the one or two soft mattresses around like chess men, from patient to patient, and of course some went without.

I called the administrator of a large, neighboring hospital and suggested that he might save his hospital untold funds by a similar purchase, since bedsores in the elderly are a way of death.  He listened politely and said he would get back to me.  It is three years now and I still haven’t heard.  In neither case was this suggestion brought to the attention of the respective boards of directors.

This calamitous inertia is the direct result of the fact that the administrators and trustees are not medical leaders, that they treat institutions instead of patients and that, indeed, medical leadership is non-existent.

Only when doctors are given a proper voice and hearing in these institutions, and given that privilege, exercise their righteous indignation at some of the improprieties foist on their patients in these institutions, will there be medical leadership in the health field.

Sincerely yours,

S.Q. Lapius, M.D. (signed)

“What do you think, Harry?” Lapius asked after I had turned the last page.

“I figure it will cost about 10 cents to send,” I told him.

“Yes, that’s about what I thought it would cost,” Lapius said.