Dear Hospital Administrators,

We accept the fact we’ve had to sacrifice every other weekend, family celebrations and national holidays for you to meet your JHACO accolades and your yearly bonus, but we think you are crazy to ask us to do more with less. To you we are simply a physician, a PA, a nurse practitioner with a brain full of diagnostic criteria and ICD-10 codes and to you we lack a heart, we should rid ourselves of emotions and quit wasting time on caring. However, what we have found is that each and every one of us is a compassionate group of clinicians. Together we wish to bring compassion and the art of listening back to the field of medicine.

We took time to carefully review the multitude of year end emails, comprised from your exquisitely catered lunch at that fabulous banquet facility. We understand the continued need to focus on “patient and family centered care”, but you ask us to discharge them sooner. No ride, no worries, we’ll send them in a cab! Get them out before 10 so we can bring in more gravely ill people with reputable insurances. Of course, that is exactly what my father said after his recent cancer surgery. And no, I am sorry, we have not heard how wonderful the reimbursement is with Blue Cross? Our CFO asks us to “spend time listening to your patients, but keep it under 15 minutes” because we need you to split those 10 hours across 25 acutely sick MRNs, yes Patient MRNs, don’t get to close with the patients. We don’t want then to know we are humans and not robots. You want to see better PRESS GANEY scores but make sure they know that their hypertension is better addressed by their PCP and not during their inpatient stay. Remind them they are here for a SBO and the small bowel isn’t that close to the heart. They’ll be fine. Oh and please pay attention to the 30 day red star readmission rates. Those insurers are really holding us accountable.

Now Mr MBA, non-licensed RN and man in dark suit, I see what you are asking and in the world of ObamaCare, I understand the need to increase my RVUs, but I’ve gotten called out by a patient for staring at the clock (in dire fear that I’ve missed a case management huddle and I’ve been reported). They’ve noticed the beads of sweat pouring when they mention that last “chest pain ” symptom with my hand already on the brass knob (quite lovely knobs I might add). They can sense the stress when they want to review their bowel habits in grave detail and I’ve already mentioned I needed to run because I have 20 other patients to see and its already 3 pm. However, this delightful young lady has had a lifetime of bowel pain and constipation and I am her clinician. With huge smile, Of course I have an extra 30 minutes for you! No worries, my daughter can get herself home from pre-school. I have plenty of time to discuss your tarry brown stools and excruciating pain with our top-notch Gastroenterology colleagues, order your colonoscopy, discuss the plan with your HCP via telephone and get the pre-op anesthesia clearance given your 30+ co-morbidities.

The problem is there is a side of medicine beyond our fee for service. Unlike our MBA comrades, we did not seek out endless years of studying, we do not sacrifice our young adult lives in didactic rounds to hear that better ROI means more $$$ for us, because it does not mean anything to us. We’ve gone years without a raise, a bonus or even recognition. Wait, I forgot to ask, how was the Cabernet at the year end celebration?

The way medicine works today, if we want to be compassionate providers we can likely go broke or completely insane stifling our emotional provider within us. I want to help those who suffer, I want to draw anatomically correct pictures of the stone lodged in your distal ureter and how a stent can help your hydronephrosis. $230K in debt to gain this knowledge and this is billed as a 15 minute visit. I want to cry with the patients and I want to show them the tumor in their lung and discuss how invasive ventilation is unlikely to improve their outcomes. But I don’t have time, because what I really need to do is go admit some newly sick patients in ER so I can bill at a higher level of care. You understand, right?

So despite earning more money for you and destroying all my non professional relationships, Why do I continue to work here? Because it is a privilege to be born with the skills to ease someone’s pain. I am honored that these hands can provide a therapeutic touch to a patient and need and because it is a gift to be able to deliver a grim diagnosis with a healthy dose of compassion. The ROI which matters is the hug from a patient’s daughter or the penned letter which arrived on your desk but was never acknowledged.

Sincerely,

Somebody on your payroll