“Thank you all for joining us today. We appreciate your time. We know you all are very busy and we hope not to take up too much of your time. Now, as you know, there are some changes we are instituting throughout the health care system and we wanted to take some time to review these with you. As you know, we have seen a slight drop off in our patient satisfaction scores and have been thinking of ways to bring those sevens and eights up to nines and tens. After much deliberation, we believe that one way in which to fix these issues is to have physicians perform twice daily bedside rounds. We believe that increased face time with patients and their families can help lead to more satisfied patients and hopefully higher satisfaction scores.”

“So, does that mean the number of patients we are expected to see will go down?”

“Huh? What? Well, no. That actually leads me to my next point. It appears the overall hospital census has begun to drop off slightly. Now, we know that it is the summer time, but we believe that we will need to scale back on physician numbers at least until the census picks back up in order to control costs. Starting in two weeks, we plan to decrease the physicians on per day to accommodate for this census change which will lead to an overall increased daily census load for each remaining physician.”

“We are already seeing close to twenty patients a day and now you want to increase those numbers further?”

“We know it may be an adjustment, but due to need for cost control we cannot justify having as many physicians on at a time as we currently do.”

“And you want us to not only see more patients but to see them twice a day?”

“Yes, we believe that this will improve patient satisfaction.”

“…. So, do you plan on providing us with note scribes in order for us to have more free time to see all these patients twice a day?”

“Well, no. That would cost money that we simply don’t have at this time. But now that you mention it, we did want to discuss issues regarding charting. We have noticed that not all the boxes regarding medication and history review are being promptly checked. Furthermore, we have heard from our documentation specialist that their queries are not being responded to in a timely manner and there is concern regarding diagnosis specifics in each note. It is imperative that each note is reviewed closely for diagnostic accuracy and that there is at least a twenty percent change each day for each note in order to ensure that each note is not simply being copied and pasted.”

“So, you want us to see a higher number of patients twice a day and spend more time on charting?”

“We want to ensure we are providing the highest level of care to our patients while maintaining the most accurate documentation.”

“What patients do you take care of?”


“You called them ‘our’ patients. But you are not a physician. You cannot practice medicine. You cannot prescribe medications. What you meant to say was ‘your’ patients unless you also plan to go through medical school and residency. Do you plan to pursue the practice of medicine as a career?”

“No, of course not! What I am saying is that we are all in this together as a team. We are all in this to provide exceptional care to each and every patient!”

“Really? We are a team? Tell me, what changes are you having to make to improve patient satisfaction and decrease operating costs?”

“I don’t understand. What do you mean?”

“Well, you just informed us that WE are going to be seeing more patients, that WE are going to be seeing patients more frequently during the day, and that WE will be needing to spend more time combing through our notes to satisfy a ‘documentation specialist’. And seeing that none of those things apply to you, what changes are YOU making? What is your contribution to the ‘team’?”

“Well, as you know, myself and others in the administrative offices will be keeping a close eye on the daily operations in order to identify areas of improvement. Although we may not provide direct patient care, we do serve a vital role in maintaining sustainability.”

“That wasn’t an answer. You may play a role but it’s not a vital one. You spend eight hours a day performing about three hours worth of work fives days a week without ever having to work holidays. You spend your time in meetings which result only in more meetings in order to discuss which subcommittee to form to address whatever problem was originally brought up in the first meeting. You then proceed to find different ways in which to enforce arbitrary metrics and goals presumably as a means of maintaining control over those with actual power. Your contribution is to serve as an overpaid whip.”

“You seem rather hostile. Where is all this coming from? This seems rather unprofessional!”

“This is coming from the fact that medicine is no longer about treating patients as much as it is about satisfying these arbitrary metrics generated by people that don’t actually matter! This is coming from the fact that your recommendations towards change has everything to do about loading us with more work without any input from us. If it seems like I am hostile, it is because I am! But my hostility is not unprovoked. You launched the first salvo when you asked more from us with nothing in return.”

“I think –”

“What if we said ‘No’?”

“Excuse me?”

“What if we said we were not going to see more patients, that we were not going to needlessly round twice in a day, and that we were going to write our notes only in a way which benefits us? What then?”

“Well… Then… You would face disciplinary action!”

“Like what?”

“Like… umm… you may face a review board. You may even be fired!”

“All of us?”


“Do you plan to fire all of us? Do you plan to fire and replace all of us overnight when we refuse?”

“Well… No. That couldn’t happen. How would the hospital run?”

“Exactly. How could the hospital run without us? We are the ones managing the care of patients and we are the ones that have the knowledge to do so. But do you think the hospital could run without you?”

“Well… There would definitely be issues.”

“Sure. But would the hospital shut down?”


“The answer is No.”

“What are you trying to get at?”

“I will be blunt. You have no control. You never did. Your power comes from our inability to say ‘No’. We are in control. We have the power. The hospital exists simply by our continued efforts. We quit and the hospital shuts down. You quit and we receive a few less emails. Neither you nor the very government that helps create the very dictates you so enjoy enforcing can make us work. The truth is that we have the final say on everything. The truth is we do not need to hate our existence. But the truth is also that we are too cowardly and ignorant to appreciate this fact. This is why you and your kind have been able to usurp all your power. But no more. We are done.

“I don’t –”

“Go back to your superiors. Tell them we are not doing anything more than what is appropriate for patient care. If they appear to be under the impression they control us, tell them we will leave. All of us. If they question our resolve, I would inform them that there will be no further warning shots. We desire to practice medicine but not in these conditions.

“Is this really what everyone wants? Does he speak for everyone else here?”

*heads nod*

“Now, please, run along. And thank you for lunch.”



It’s fun to dream.

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