You're part of the team or part of the problem

August 1, 2005

If you have had anything to do with children in the last 10 years, you are probably familiar with Bob the Builder. Bob, Wendy, Scoop, and the gang are claymation-like TV cartoon characters. In each episode, Bob and the gang team up to overcome a challenge. Their motto is "Working together to get the job done." Kind of like the healthcare team.

If you have had anything to do with children in the last 10 years, you are probably familiar with Bob the Builder. Bob, Wendy, Scoop, and the gang are claymation-like TV cartoon characters. In each episode, Bob and the gang team up to overcome a challenge. Their motto is "Working together to get the job done." Kind of like the healthcare team.

When I entered healthcare back in the dark ages, the team and the goal were well defined. Physicians were the primary leaders; health and wellness were the goals. Nurses and ancillary workers followed our lead, assuming that all those years in training had taught us something. Payers, both the government and insurance companies, made medical care available to the majority by spreading the financial risks among us all.

It seems to me that the team has changed quite a bit in the last 25 years, and our goals are increasingly disparate. Not that we are unique in this regard; just look at major league baseball or our legal system.

One change I see daily is the decline in respect for eight or 10 years of medical training. Patients and family will Google a topic and then argue with a physician. High school grads working for insurance companies routinely question the appropriateness of a physician's orders. In my experience, the ones who question my decisions and judgments least are the radiology technologists, and they are the ones who come closest to our level of experience and training in our field. I value their input. I couldn't care less if Uncle Dave thinks Mom should have a CT instead of an MRI.

Nursing has undergone a sort of schizophrenic metamorphosis. Good clinical nurses are amazing. A whole new breed of administrative nurses with a flurry of capital letters after their names has emerged, however. Why do advanced degrees and increased administrative duties seem to be more highly rewarded than bedside nursing? Degrees and lists of duties are objective. Deciding who has the best bedside skills is subjective. It is a lot easier to design a pay scale based on objective data.

The government is schizoid about medicine too. Legislators are quite willing to promise more healthcare; they just don't want to pay for it.

It is political suicide to consider limiting medical care. The government underwrites roads and bus systems so we all have access to transportation. In medicine, Congress insists on equality: Everybody gets a Cadillac. And more often than not, they get a couple of new ones right before they die.

The biggest change has been the malignant growth of private insurers. Spreading risk and providing care are no longer their primary goals. The goal is profit. Like so much of corporate America, the greed of executives is disgustingly self-evident. The average salary for CEOs is now 350 times the average worker's salary of $12/hour.

Blue Cross/ Blue Shield provides a classic example. For years, this company was nonprofit, providing healthcare for millions while still managing to pay their senior executives more than the average physician earned. A few years ago, greedy executives took the company private. Every policyholder has seen rates rise, and every provider has seen reimbursements fall. Four Anthem BCBS executives reported over $20 million in income last year, with the senior exec making over $60 million. Clearly, the goal is not providing healthcare; it is bleeding the system as quickly as possible before it Enrons.

Unfortunately, healthcare seems a lot less like Bob the Builder these days, and a lot more like the U.S. Olympic basketball team.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at btipler@medicaltees.com.