Reader feedback.

Dear Editor: Reader wonders how to restore professionalism to health care.

With a concerned and gracious style shared by today's best physician executives, Robert Klint, MD, MHA, FACPE, in his article titled "Is the Business of Health Care Hurting the Profession," (The Physician Executive 28:3, May-June, 2002, p. 4.) urges us to seek success by remembering our roots. Until recently, such voices were few and unheard, especially by CEOs forged in fierce fires of finance, acquisitions and investor profit. Patient care was a distant or forgotten notion.

But today, the voices of those calling for internal reform are a gradually swelling chorus. And why not? If there is any good for us in Enron, it is that we have been yanked to our senses. How far are some of us from deserving rediscovery of the word, corrupt? Unthinkable, perhaps. But if so, only to providers who circle the wagons and ignore the tragic loss of public confidence in health care, a private sector social service business from which people expect better. The changes we must make are not altruistic. They are for our own good. Survival of private sector health care is not a foregone conclusion. If we do not change our direction, we may end up exactly where we are headed.

Restore professionalism then, but how? Here are four discussion topics for your next executive management meeting, board retreat or physician leadership conference.

Explore ACPE's notion of Leading Beyond the Bottom Line management. (1) Pretend you are the patient, client, or resident or enrollee. In meetings and in one-on-one discussions constantly remind each other that "(while) health care institutions are, in fact, business organizations with most of the problems faced by corporate management...they differ (in that) health care holds a special place among human needs. (2) Focus sometimes on the microdimensions of health care. (3) The macrodimensions of health care are organizational issues and the extraordinary and complex technology. These are the areas in which we are most comfortable. The microdimensions of health care are professional and interpersonal issues, daily common humdrum routines and clinical expertise. These are huge components of our business and we must become comfortable in these areas as well. Think on beyond compliance. (4) Compliance with regulations, laws and industry standards is important, but it is not a sufficient endpoint. The compliance-on ly management style is all defense and in baseball, soccer and health care, one cannot score when on defense.

Be proactive. Try to do at least three patient-centered things a day that are not mandated by some agency.

Take the long-range view. This is the simplest but hardest key to internal reform. Instant gratification is the watchword of American business. But sustainability of the private sector U.S. health care system requires providing for tomorrow, as well as taking a reasonable profit today.

Richard E. Thompson, MD

Springfield, Mo.

References

(1.) "Leading Beyond the Bottom Line." ACPE News. Sept/Oct 2000, 3(5), p. 7.

(2.) Hall, RT. An Introduction to Healthcare Organizational Ethics. Oxford University Press, Oxford and New York. 2000. pp. vii-viii.

(3.) Worthley, JA. The Ethics of the Ordinary in Health Care. Health Administration Press. Chicago, 1997, p. 3.

(4.) Thompson, RE, MD. On Beyond Compliance: Thinking Inside a Brand New Box. ACPE. Tampa, Fla., 2001. p. 24.

Keep ethics in mind when pursuing new revenue.

The article in the July/Aug, 2002, issue of The Physician Executive, "Strategies to Boost Your Income, Enhance Your Bottom Line," by Maureen Glabman advises several techniques, some of which are of dubious ethical content and others with potential for unethical behavior.

The list "10 More Ways to Make More Money," which well might have borne the subtitle "Anything for a Buck," suggests selling or distributing varied products as an office sideline. The Code of Medical Ethics of the American Medical Association states that in-office sales of either health-related or non-health-related goods presents a conflict of interest, risks placing undue pressure on the patient and threatens to erode patient trust and unmermine the primary obligation of physicians to serve the interest of their patients before their own.

Signing up as an online practitioner, mentioned in the article, may place the physician in violation of the Opinion on Physician Advisory on Referral Services by Telecommunication in the Code of Medical Ethics, which states that physicians should not make a clinical diagnosis and under no circumstances prescribe medications when the sole contact with the patient has been by telcommunication. In addition, such actions may be prohibited by state Medical Practice Acts in some jurisdictions.

While there may be valid practice-related issues for the addition of a physician assistant or nurse practitioner, establishing an office-based laboratory or even providing some complementary medical services, adding such services should not be primarily related to enhancing profitability, and physicians who do so have the obligation to provide professional oversight and to avoid recommendation of unnecessary services.

Frank Riddick MD, FACPE

New Orleans, La.

The physician executive wins national award.

The Physician Executive journal won the 2002 Gold award from the American Society of Healthcare Publication Editors for "Best Series of Articles." The series that won appeared in the Sept/Oct 2001 issue of PEJ. Titled "Patients and Understanding," the series explored the state of the doctor/patient relationship.

Competition for the award included health care publications from across the country. Credit for this award should go to the authors who contribute their articles to the journal, the peer reviewers who read and evaluate the articles, the hard work of the ACPE team that plans each issue of the journal and the ACPE staff who lay out and proof the magazine.

Thank you,

Bill Steiger, editor