Hospitals Tell Doctors They’ll Be Fired If They Speak Out About Lack of Gear
bloomberg.com
bloomberg.com
https://www.nytimes.com/2020/03/31/health/hospitals-coronavi...
How do we put a swift end to this nonsense? Surely the public will be overwhelmingly on the side of doctors, nurses and other healthcare workers.
Unfortunately, new entrants to the hospital market are prevented by large state-sponsored moats, and most of the large incumbents are shady in similar ways, so the ability of the staff to choose employer based on ethics/practices is basically meaningless. More options for medical care and medical employment is the answer; the vast majority of people in society are not greedy/shady.
Fix one, and you fix the other. You might also bring prices down, too. (Caveat: it's not "swift", as you requested.)
Not always or completely even. Medical residents and fellows enter a legally binding contract to work at the hospital they match with as part of the application process, and opting to change hospitals during one’s program is nigh impossible.
Ethics/practices vary a lot between countries, and it only takes a small percentage of professionals moving away from one country to a better one to motivate change.
We can't continue to live in this fantasy where companies have so much power over workers and their futures. But changing this involves organizing labor, which is deeply stigmatized in the US.
Hospitals also are fairly well insulated from negative PR as well since they don't operate in a free market, which prevents patients from being able to choose to go elsewhere.
A cynical would say.
The chronic shortage of doctors? Well, that's because they're perhaps the strongest guild. The AMA puts a cap on the supply of doctors (via # of residency slots they allow). The PAs were invented so that another class of workers could do the work of doctors without jeopardizing the doctors' pay or status.
They are not saying that doctors invented PAs to solve the chronic shortage, they're saying that doctors created the chronic shortage which necessitated policy intervention in the form of PAs.
I think you've just misread the comment and would find that it actually agrees strongly with what you said.
This is factually untrue.[1]
It’s worth noting that the AMA also is structured in such a way that gives undue influence to specialist physicians over GPs and ER docs (their representatives essentially get more votes over group policy decisions).
I’d actually argue that physicians haven’t yet fully grasped their power. Historically, many docs worked in independent clinics or small practice groups. That made them subject to antitrust law when teaming up to negotiate en masse against a large insurer, for example.
Today, with all of the consolidation over the past decade, many have become employees. This has made them less powerful in many ways... except, now they can unionize without any of those old antitrust concerns.
USA could do like they do in tech and import already educated people. In tech we welcome that, in medicine that process requires the immigrant doctors to take additional years of study since medical doctors in USA have a post grad degree for no good reason.
I’d argue that Sanders’ lack of success in the polls is due more to voters’ perceived safety in choosing a moderate to beat Trump rather than disapproval of Sanders’ policies. Everyone has become a pundit and believes that the electorate will only tolerate a moderate while many of those same voters voice approval of progressive agenda items like Medicare For All.
Americans are seeing now more than ever just how much they’re valued when our system fails. Unfortunately, it’s going to result in hundreds of thousands and deaths and ruined futures for so many more.
Now why hospitals are demanding that doctors keep quiet about the consequences of emergency operations under extended use protocols? That's an entirely separate issue. Those hospitals should be named and shamed.
But I completely understand restricting PPE to needed areas. The solution to that is to manufacture more PPE. But if we're not going to do that then extended use protocols are just military sense.
When every healthcare worker starts defying these types of rules. What are they going to do? Fire all of them?
I agree collective action is the path to long term success, but these workers should not feel a gun is being held to their head by health system administration.
Hospitals are... businesses. They will prioritize their financial success over all else which is to be expected. This sort of press is bad for business, especially long term. They are not concerned with public health, they just happen to house a few people who care about public health.
Fortunately for medicial doctors, they're in such high demand that I don't think any sort of job security is an issue. Iff hospitals and state/federal governments are doing everything they can to obtain PPE (which I believe they are) then I can understand from a public health perspective why you dont want undue stress/panic across the masses (which may result in massive hoarding of PPE for themselves amongst other things), I think it's in the public's interest to know the situation so they may act even more carefully to try to prevent needing to go to hospitals to begin with.
Sometimes knowing about a problem doesn't help much about solving a problem and only causes mental stress--or leads to more problems (mass panic and injuries/fatalities due to this).
I somewhat suspect a lot of this slow rollout of self-isolation process also modeled out public reactions, increased 'escape' travel, hoarding, panicking, etc. and a lot of the rollout dates and gradual release of information of how bad the situation really would be was more planned out than is often suggested. Combined injuries/fatalities due to panic behaviors combined with infection vs slow rollout of isolation. The federal government has access to sophisticated modeling and they typically look at scenarios from a more holistic perspective not just epidemiological related deaths.
When you looked at all the initial data coming from China, we knew this was going to be bad but somehow pretended it wouldn't be and are slowly warming up to accepting the situation. Some of it may just be pure denial, "this cant happen to me" mentalities.
It was pure incompetence that led to the slow rollout.
I support emergency whistleblower legislation prohibiting any health care employer (perhaps any employer) from engaging and discrimination or adverse job actions on the basis of an employee's good-faith effort to make a non-negligent report in the public interest of a matter that has previously been reported through internal channels that the employee was aware of and were not overly burdensome.
What would lead you to believe that "will of the public" commands any agency at all? In a functioning democracy this would be a powerful force but we've had our democracy subverted by decades of corporate interests controlling more of our government at all levels.
The United States is a democracy in name only, it's a useful myth that keeps the public feeling safe but that illusion increasingly seems less useful.
Unions.
Nice thing about unions, though, is with them it rarely reaches a point like that.
It's a known, lethal, virus, and they're not letting people protect themselves, especially if they aren't providing that protection themselves.
They must "Provide a workplace free of health and safety hazards that can cause death or serious injury;"
https://employment.findlaw.com/workplace-safety/protecting-y...
Perhaps they'd rather get a call from OSHA? Would they perhaps prefer their nurses call OSHA first?
In Florida, there's a law for whistle blower healthcare workers. https://www.nationalnursesunited.org/whistleblower-protectio...
If the choice is be fired or die (or have a better chance of dying), they should file an OSHA violation and call out.
The practices nurses/doctors are doing today are in violation of OSHA (mask/shield re-use and the like) and they would have been fired or strongly reprimanded just a few months ago for doing what they are being told to do now. To add insult to injury they aren't letting them protect themselves because it would further prove how unprepared these hospitals were.
No, keep yelling about it loudly to everyone! We get that a hospital can't magically fix PPE issues - but that doesn't mean that you can just suppress stories about it.
If enough medical providers are fired who are desperately needed, the government will step in to replace health system administration.
We could open up massive free clinics in every city tomorrow morning. Nothing is stopping us.
What a garbage interpretation of what is going on. Jesus Christ, I'm jaded and cynical, but that's just too much.
Saying that we don't want to overwhelm our medical capacity because of the billing, versus the actual reason of human deaths. Too much. That's just too much.
Every cog in that machine is still spinning along, wasting massive amounts of time and resources. ER docs are still on the phone fighting insurance companies, while treating covid patients, right now, today. This is reality.
If you complain about any of this you will be fired by the hospital you work for.
Either the rules of civil society apply to everyone, or they apply to nobody.
When people with power brazenly disregard those rules, but expect everyone else to keep following them, the correct response is to not sit down and shut up.
Second, given that the hospitals' priority seems to be protecting their own reputations over the health of their employees what makes you think that allowing them to act as they see fit during this crisis is the "pragmatic" approach that will lead to fewer deaths? It's plainly apparent that safety is not at the top of their list, maybe a leadership adjustment will save lives in the long run.
Unfortunately, there are some bad apple physicians who are very aware of the power they wield and if they feel something needs improvement, they will be extremely vocal... Sometimes at the detriment of the truth.
I've been subject to the spread of misinformation by a couple of physicians related to some past projects, and it's not pretty. All you can do is try to re-educate these same physicians who are misunderstanding some facts, and as you can imagine, it's an uphill battle.
I would make the effort to understand both sides of the coin before assuming these "big, bad" hospitals are in the wrong. As they say, the truth is often somewhere in the middle.
Evidence from Spain suggests medical professionals on the frontline are at very high risk.
maybe you can share why you think it is unfair on the hospitals in this case ?
It really boils down to how long certain ppe can be used, what is the risk of infection from reused ppe and how to sanitize ppe effectively.
I'll leave the dispute over the facts to the experts but from my understanding that is the source of the conflict over ppe.
Anyone who has ever worked for a living should not be surprised that this sort of behaviour is alive and well here, too.
It's not just that they'll be fired if they speak out...
The hospitals are also threatening to withhold worker's compensation payouts if a staff member is caught using anything brought from home, even if it's real, name brand equipment. Got some N95s leftover from that home improvement project? Leave them at home and use this surgical mask instead (still better than nothing, to be fair). They are asking staff members to inform on other staff. To be clear: these policies were in effect for an area with coughing COVID patients. They do put surgical masks on the patients, which is very helpful, but I'm livid that they then ask the nurses to NOT use N95s in this scenario.
They are also undertaking dubious re-use and cleaning procedures that are not scientifically proven. For example, masks (both surgical and N95s, which are only for workers doing things like intubation) are being used for an entire day (also not correct usage) and then placed in paper folders for a week. At the end of the week, the masks are deemed 'clean' and reused by the same staff member. Kind of like a mask for each day of the week. There is not strong scientific evidence this is an effective or safe procedure. These procedures might work, but there isn't testing proving that fact.
I understand hospitals are in a bind here. There are simply not enough masks available (both surgical and N95) in the world. If the hospitals admit their ad-hoc procedures are ineffective they risk short term mutiny in their staff ranks. They also risk long term litigation by admitting they can't protect staff. Unfortunately their approach of 'clamp down hard on dissent' is preventing the real message from being broadcast loudly enough: It should be blindingly clear we need a crash program to ramp domestic PPE manufacturing by an order of magnitude (or two).
As an aside, please call your senators and representatives and ask them to force the Trump administration to use the DPA to bring more PPE capacity online. It's really too late now, but better late than never. We'll need to establish permanent manufacturing capacity for this anyways so we never get caught out like again.
I'll also speculate that it could create friction between staff - How come you get protect and I don't? It could be a problem.
I think I remember someone who was a new-ish doctor mentioning that part of the reason some doctors' salaries were so high was they had to basically pour money into malpractice insurance.
1. Regulations against using non-approved medical equipment of unknown provenance. 2. A worry about health care workers who don't have stuff they can bring from home. It's not as if you can go about and buy an N95 mask right now. If some of the healthcare workers have respirators that they have lying around at home and some don't then it could cause friction on the unit.
1. All regulations are pretty far out the window at this point, nurses are already reusing single-use items all over the place.
2. Oh so since we can't protect everyone we can't protect anyone?
On the second point I would actually be more sympathetic to their position (though probably not enough to actually ban employees from doing it). Humans are funny and if some people on a unit have better equipment than others it can certainly cause some interpersonal tension that over-stressed hospitals can't deal with right now.
They should be protecting the people who can actually help save other people even if they can't protect everyone. Should nurses in KY stop wearing masks because nurses in NY are out? I understand you point on "interpersonal tension" but people need to get over it right now and protect themselves in whatever way possible even if that means I walk into a hospital and see a nurse with a bandana over their face (already happening in some hospitals AND part of the CDC "Strategies for Optimizing the Supply of Facemasks" [0] -- Read the "HCP use of homemade masks" section)
[0] https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/f...
I was disciplined for bringing in a reusable respirator. The reason given was that it made other staff believe the health system wasn't doing enough to protect employees and creating extra fear. And yes, I was threatened with termination in the middle of this crisis.
It needs to be addressed or it will repeat in some other context. Right thing to do is get cool heads in mgmt to handle the hot heads in mgmt. Small changes in comms can prevents such distracting/harmful escalations. And experienced managers/admins will know how to make it happen.
Actually failing to protect staff seems a worse litigation risk.
For those of you who are unfamiliar to how medical training works in the US, residents have _no_ power. If they quit, they cannot become board certified, and effectively cannot practice in any capacity. 4 years of college, 4 years of medical school, and 4-7 years of resident training.
But if I have to choose between speaking out and dying, I would probably speak out.
and, probably, the most efficient: vote for the people who are knowledgeable, listen to scientific advice.
of course, a better solution would be to implement a system where the goal of healthcare will be not profit, but the health of the general population.
when the medical professionals who are fighting in the front line trenches say we don't have enough PPE, react by providing the said PPE to said medical professionals.
when medical professionals say things are going to get worse exponentially, provide them tools to fight the contagion instead of proclaiming "it's a hoax" on the national TV.