Dr. Robert Wachter has a great column in today's USA Today: “Column: Gregory House M.D.: RIP” and it's republished on his blog, with its own comment section.
I wrote a comment, which is awaiting moderation, and I'll repost it here…. also curious to hear your comments on his blog or here on mine.
From his column:
Hospitals were co-dependent. All too aware of their heavy reliance on the physicians' control over their revenue stream, hospital administrators learned to coddle doctors, with everything from prime parking spots to a personalized menu of surgical equipment. This kept the doctors happy, but also led to wildly expensive and sometimes risky variations in practice, even within the same institution.
This reliance also made everyone tiptoe around the dysfunctional behaviors that Dr. House so memorably illustrated each week. In one survey of more than 700 nurses, 96% reported seeing doctors engaging in disruptive behavior, and almost half pointed to fear of retribution as the reason such acts went unreported. Another survey found that one in four doctors and nurses believe that disruptive behaviors are associated with preventable deaths. I agree, having seen cases of medical errors in which a scrub nurse or physician trainee suspected that a senior doctor was about to commit a terrible error, but kept quiet rather than risk the physician's ire.
My comment:
Great piece, Dr. Wachter. I grew tired of the show and the character… he's a drug addict, but he's talented. He's misanthropic, but boy we sure need him.
As somebody who was an outsider to healthcare seven years ago (from an engineering background), I was blown away by the disruptive behavior that was reported and tolerated in hospitals… behavior that wouldn't be tolerated and excused in most workplaces.
You say hospitals “were” dependent on physicians for their revenue stream… I think that's still often true in the current tense.
As more hospitals embrace the “lean” management methodology, they learn that one of the two pillars, from Toyota, is “respect for people” — and how that mutual respect is required to have an environment of safety and quality. It will be interesting to see how healthcare reconciles the old mindsets with the new mindsets of lean and the modern patient safety movement.
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The first few seasons were interesting, before the plots had to get so ridiculously unbelievable. The retrospective filmed by Hugh Laurie was a contrast, however. Much respect for everyone from the directors to the caterers to other actors.
I refused to watch “House” over the years because of the notion that his behaviour should be tolerated because of his brilliance. “Respect for people” is a practice that we must embrace in healthcare if we expect quality to rise and errors to be eliminated, and shows such as “House” can (in my opinion) take us the wrong direction.
I thought all this time that House was a fictional character….
Yes, House can be off-putting, but at the same time, most people find some appeal in him because of his rebel spirit. Does anyone remember Hawkeye Pierce?
And doesn’t House exemplify the practice of the scientific method? Isn’t that the basis of all improvement?
Yes, House is fictional, but there are many real physicians who behave badly – and their behavior is tolerated or excused. The scientific method is important, but so is the dual Lean (from Toyota) principle of “respect for people”.
Hi Mark
I was never really a fan of the show, knew to many people like that in the real world, and yes there are many of them in all types of companies. Why it is tolerated, shows the total lack of respect many organizations have, when they manage by numbers.
I call them tyrants, and they can be very successful people, when economies and opportunities are in short supply for people to go else where. But in all fields, we have to remember that things change and as soon as opportunities open up good people will leave because of these types of people, and the organization that tolerates them will pay the price for it.
Many hospitals and businesses have lost people that would have contributed more and caused less grief, by allowing the ego cases to go on unchecked. It may surprise most but most ego case when stopped rarely leave they are more affraid of the rest of the world. Bullies are Bullies and they are most often cowards as well.
In this day and age Respect for People only thrives, when profit is not the only focus of a business. In fact it is the worst focus you could have, try focussing on doing the right things to create a great product or service, in the best way, profit is just the by product of doing other things well.
Good post, Mark. I never “got” the House thing. He disgusted me more than I felt any sympathy. Certainly not a model for respect, that’s for sure.
I enjoyed House till it got all convoluted. I actually Liked it BECAUSE of his cockiness.
As a patient with a very hard to pinpoint and diagnose disorder, I grew tired of doctors that were wishy washy and refused to tell me they didn’t know what was wrong with me and instead, opted to treat a myrad of diseases I DIDN’T have. I have been put through YEARS of unnecessary treatments because the doctor was too busy to really LOOK at me. They had so many patients that I felt more like a customer in a conveyor system. I even had one doctor once that diagnosed me with testicular cancer and I’m a woman! He came in, flipped open the chart and said “Sorry, sir, I’m going to refer you to oncology.. It seems you have testicular cancer” turned and rushed out!
The doctor I have now is abrupt, arrogant and has the bedsid mannor of a baracuda but, he diagnosed me and, after trying new, unheard of treatments, I was found to have Fibromyalgia. He’s been my doctor far three years now and because of his straightforward and insistent treatments, I’ve lost 95 pounds, gotten off the diabetes meds (A1c now 4.5 VS 8.9) and generally am healthier than I’ve been in 20 years. Some of us NEED a doctor like him!
Love the blog, btw
Sheila