Dr. Roy Poses-- Our Dysfunctional Health Care System, Including Psychopaths

Broadcast 11/15/2014 at 8:12 AM EST (23 Listens, 22 Downloads, 1641 Itunes)
The Rob Kall Bottom Up Radio Show Podcast

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Dr. Roy Poses-- physician on the faculty at Brown University, runs a blog called healthcare renewal about our dysfunctional healthcare system-- and problems caused by bad governance, bad leadership leading to concentration and abuse.

http://hcrenewal.blogspot.com/

Rough Interview Notes:

Rob: I originally encountered your work by seeing an article you'd written on how privatized healthcare may have made the response to Ebola worse. Can you talk about that?

Even non-profit hospitals feel they must compete with for-profit model hospitals.

Profit hospitals make money on elective procedures. And managers don't like to spend money on excess capacity on things that won't be used every day. So such".

Rob: did that turn out to be the case

Poses: It looked like it in the unfortunate case of Mr. Duncan-- the patient who died in Texas. In retrospect, they ".

Rob: How would it be different if we didn't have this for-profit system?

Poses: I would like to think that in a non-profit and community-based hospital admins would figure out what they would need to be more prepared for what came along rather than being focused on profits in the next quarter".

Rob: Have you looked at other countries that have less privatized systems, how they have responded to Ebola?

Many European countries have, to some extent followed the US example--

Rob: with orgs hiring business people to run hospitals?

Poses: Even the most socialist system, like the one in Britain, has business people in management.

Rob: So it's not necessarily privatization that's the issue.

Rob: What would you say is the more ideal alternative?

Poses: For a long time, car people have complained that the auto industry has been taken over by the bean counters or business people.

" if you put accountants and managers in charge of companies wihen they don't know what the company is really about".

Rob: So what is your alternative?

Somehow we have to encourage leadership that really thinks about the healthcare mission== what it takes to take care of patients, about the public health-- that puts the mission first and the revenue second as an enabling factor.

Rob: It seems that patient care and public health have become externalities in the health care business.

Rob: So, the US is setting a bad example of rather nations. Are there other countries that are doing things better?

I've heard anecdotes that at certain hospitals and companies things are better-- but those can only be identified because there haven't been problems.

We don't have the best health care system in the world.

Rob; Based on what criteria?

commonwealth fund reports every year on a number of quality metrics- and costs- we are way up there in terms of cost-- we are number one. On quality measures we are mediocre.

Rob: How do the health care profession, industry and doctors respond to your blog?

many people are worried about speaking out on this topic

Rob: Why?

colleagues, friends, supervisors are benefitting"

Rob: Let's talk about corruption-- about payoffs. Your blog has a more recent article about that:

• Drip, Drip, Drip - the Steady Accumulation of Little Cases Leading to Big Problems

There are literally billions of dollars being paid out by companies" to health care professionals.

Rob: your article suggests that the DOJ is, like it has done with big banks, is not prosecuting any people in big healthcare-- only fining companies.

they get a settlement from the company, but not ". any individuals who may have profited from it. And the settlements come from general funds from the company, so they come out of the pockets of the shareholders, patients".

Rob: Another issue you've brought is health care records problems.

Scott Silverstein-- writes on the block on medical informatics. Pointed out that bad health record at Presbyterian in Dallas could have led to Mr. Duncan being sent home.

Records have been developed by big, for-profit corporations-- It looks like most of the systems have not been developed with an understanding of the demands of a health care environment-- they're more designed for health billing and management (rather than patient care)

Silverstein has documented examples of numerous things going wrong, endangering or harming patients.

Rob: personal experience and reports of Doctor's who were promised their work and lives would be better if they sold their practice to a hospital, but it's actually worse

Poses: it comes from this

Rob: It's probably true that business managers make things better for business.

If your only metric is quarterly revenue, that's one thing

Rob: is there any kind of movement by healthcare providers to resist this?

There'a a lot of unorganized"

There's the nurses who complained anonymously.. and one who complained non-anonymously.

Rob: I don't think that health care providers, who come from hierarchical systems have any training in activism

HC professionals think they have organizations-- medical societies" have funding from outside sources-- like the for profit companies we've been discussing. They often find that there is no help there.

Rob: Would that apply to the AMA?

It's unclear. None of the societies are compelled to reveal their funding sources. I believe they get more from other sources than member dues.

There have been instances where the fact that a society is funded by a particular company has come out. But it's really not known, but my impression is many of the bigger professional societies get their funding from corporations.

Rob: what affect does this influence have on these societies

" policy guideline processes" underwritten by companies in a position to profit and people in the societies have been found a relationship with the companies.

There's an awful lot going in healthcare that really isn't transparent".

Rob: what else, what are some of the other issues have you addressed in your blog that are important to you?

Poses: conflict of interest issues regarding government-- the revolving door-- recent people in govt who either came from or went back to healthcare corporations who may have affected their decisions.

Rob: Can you give any examples? How about the FDA?

Poses: The FDA has a somewhat different problem in particular. It uses a lot of advisory committees and the members often have a conflict of interest.

The most recent revolving door issue that I brought up was the new director of VA veterans affairs was at Proctor and Gamble.

Rob: The idea of the best thing is to have a business guy-- It's like a religion.

Poses: I think it's become a religion

The idea that business managers have some sort of magic understanding of the world, which will fix anything. It's huge social experiment.

Rob: Any other issues?

Poses: In healthcare you have to look at every piece of a very complex system and look at how much they care about patients.

Rob: Caring and Psychopaths-- Caring

Poses:I'm going to mangle this quote, but the secret of patient care is caring about the patient. I hope that most HC professionals have that in their heart, but the system doesn't. Cite's Snakes in suits.

The current HC environment makes it easier for psychopaths and sociopaths to get into management-- You are

Rob: tell me more about your consideration on this.

non-violent psychopaths are not rare-- an a major feature" is that they cannot care.

They do very well in healthcare. Wrote something in 2012 about the Corporate Psychopaths--

Rob: have you seen things happen in HC that suggest the hands of psychopaths and sociopaths.

I've seen health care leaders incapable about talking about anything but profits

Rob: Can you give examples of how that might manifest in a hospital

there are lots of decisions that are between patient care"

Rob: Do hospitals and the healthcare system have any ways to protect patients and hospitals for psychopaths and sociopaths?

Some objective testing of leaders screens for people with those tendencies.

If you lean more on quantitative skills you may enrich the mixture of psychopaths"

This is a policy issue is largely ignored.

Rob: the challenge--

It's about favoring people in leadership who DO care about patients. There probably things that psychopaths can do to benefit society, but it's about channeling them where they won't hurt anybody. I don't think anybody is talking about.

Rob: such a simple concept--- including assessment of caring in evaluating leaders.

Rob: We have about two minutes left. Anything you want to wrap up with?

need to increase awareness that our health care needs a lot of thought, attention, fixing. It could be the best healthcare system but it isn't now.

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