Leaders in academic medicine should channel Ganesh

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Category : Medical Rants

Last night I had a wonderful dinner with a previous family medicine resident and his family. He now works as a hospitalist. I knew that he was celebrating Ganesh’s birthday –Ganesh Chaturthi 2013: Hindus Celebrate Birthday Of Lord Ganesh For Auspicious Beginnings Being fascinated with religions, I asked about Ganesh and he and his wife taught me. I knew that Ganesh favored learning, but I was unaware of the phrase “remover of obstacles”. Hindu’s pray to Ganesh when starting new projects, as he removes obstacles to success.

Although he is known by many attributes, Ganesha’s elephant head makes him easy to identify. Ganesha is widely revered as the remover of obstacles, the patron of arts and sciences and the deva of intellect and wisdom. As the god of beginnings, he is honoured at the start of rituals and ceremonies. Ganesha is also invoked as patron of letters and learning during writing sessions. Several texts relate mythological anecdotes associated with his birth and exploits and explain his distinct iconography.

What struck me during our conversation was the concept of removing obstacles! Can you remember praising a leader for removing obstacles? What I see in medicine today and in medical education today is a series of obstacles! Who is working to remove those obstacles?

While Medicare is in many ways a huge success as a health care program, unfortunately it often represent the anti-Ganesh. CMS creates rules that really are just obstacles to care. CMS focuses on payments and the budget. The rules, however well-intentioned, create obstacles. How can we decrease the obstacles to spending adequate time with patients, writing intelligent notes and decreasing health care costs.

ABMS (the American Board of Medical Specialties) and ACGME continue to add rules for residencies. Residency programs spend inordinate time in documentation, while residents spend less time with patients and seemingly are not learning medicine as well (decreased board pass rates).

We in academic medicine, we in medical societies, and perhaps other health care leaders should reframe our conceptualization of health care. We need to channel Ganesh and work to remove obstacles. We need leaders who refuse to accept obstacles!

Comments (6)

If you want removal of obstacles, more time with patients, meaningful and concise notes, you need to go to a different practice model.

Insurance companies and govt are the complete and total cause of all the obstacles. They won’t remove obstacles, they function by obstacles. Expecting them to decrease oversight, mechanisms of control, and regulatory burden will only lead to ongoing disappointment.

The better question is why are the obstacles there? Are they there to help make a more educated decision or are they there to just be there. I think a whole massive change needs to happen but again change doesn’t just happen.

Current obstacles: CPT, ICD 9 and 10, P4P, EHR, MU, PCMH, RUC.

Will the medical societies work to remove those obstacles, or will they continue to support them?

Excellent ideas. Too bad you’re not running things.

The only thing an individual physician can do is to “go to a different practice model”, which basically means refusing to take Medicare or Medicaide patients or to have a concierge practice. Many doctors are doing this, which unfortunately limits care to certain categories of patients. My wife is an example – she had to find a new doctor when her old one quit taking Medicare.

Currently I think there is little hope that medical leaders will effect a change. These after all are the guys who run the ABMS and ACGME and who have been largely silent while the current lousy situation developed. Now there are enormous financial stakes at risk for the industries which code, bill, review “appropriateness of admissions” and appropriateness of coding for Medicare, and come up with the things that RSW has mentioned. Clearly there has to be some kind of oversight but it should be designed to help rather than harm delivery of care and it will be very hard to trim this monster back. I think it’s the nature of organizations to expand their roles and make things more complex, whether it be JCAHO, the ABIM, Medicare regulators or even homeland security, particularly when there are jobs and money involved. It’s one think to say we should refuse to accept obstacles, but if you dont have a limited practice and you want your patients to get care, and you want to get paid for the work you do, you have to deal with it.

I enjoy your blog. An academician who makes some sense! Good luck with your efforts.

The road to bad care is paved with well-intentioned mandates.

Amen!

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