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December 21, 2011

Occupy Health Care!

Last night, I went into my call room and realized it was occupied.

There was a sprightly girl of about 20 with a nose ring, a shaved head and a sign that said, "We are the 99%!" There was a white Rastafarian with a proper Oxford accent wearing Doc Martens and a yellow isolation gown, banging furiously on a drum. And there was a bespectacled young man dancing around as if in a trance and wearing my stethoscope around his head, making it look like a loose weird proboscis. I thought I was dreaming. After all, it was late, and after admitting 20 babies with RSV, my mind was partially numb.

But, no, I wasn't suffering a ketamine-induced paranoia. My call room was occupied.

"What the ... !" was all I could exclaim before the girl approached and put a finger to my lips.

"Relax, Doc. We'll be leaving soon. We wanted to make sure you knew you were not alone."

"My dear, I'm not sure what you're talking about! Look at my 401(k). Look at my benefits! I am not one of the big cats that prowl around Wall Street! I am not the 1%!"

"We know, Doc. See, we heard you howling at the moon out there. Protesting about inappropriate admissions, unnecessary procedures and tests, defensive medicine. We heard you complain about medical education and about how length of stay has nothing to do with quality. We wanted to tell you that you are not alone. You are one of us!"

I sat on the bed, wondering if the hospital was bugged and if some Big Brother security apparatus was recording our conversation.

"See, Doc," said the blonde Rastafarian, adjusting his yellow isolation gown around his gaunt waist, "we hear you. We want to be like you."

"Wait," I responded astounded. "You're medical students?"

"Of course, Doc," said the bespectacled young man. "How could we have gotten inside your call room?"

"But," I grabbed my head as it began to pound, "you should be aspiring to plastic surgery or anesthesiology, specialties that will pay you enough to cover your student loans! You should aspire to be the 1%!"

"We'll change the system, Doc," said blonde Rasta. "In post-occupy health care, malpractice lawsuits will disappear so there'll be no need to practice defensive medicine. Doctors and nurses, not administrators, will set the agenda. There will be no corporate or pharmaceutical influence. It will be a world without RVUs, without length of stay, without …"

I woke up. The sun was piercing my eyelids as bright as an otoscope. I sat up and found a yellow hospital gown wrapped around my ankles. Did I dream it?

Of course I did. There will not be a world without RVUs or defensive medicine. After all, one of the latest important hospital metrics is the "patient experience," as if patients came to hospitals for the newest roller coaster or a bamboo-and-mud massage. Or do they? When surveying patients, the questions are all about how the doctors communicated with them or if the nurses were responsive to their needs—hardly scientific measures of quality health care.

But aren't these the same concerns as the Occupiers? According to the Occupy Wall Street Web site, the group's goal is "fighting back against the corrosive power of major banks and multinational corporations over the democratic process, and the role of Wall Street in creating an economic collapse that has caused the greatest recession in generations." What if we trained the occupiers' sights on big pharma or hospitals, or health care in general? What if the occupiers decided to occupy health care?

And what would be its goal? I propose that the mission of "Occupy Health Care" be to protest against the undue influence of the corporate world—including pharmaceuticals, insurance companies and hospitals—on the decision-making process of patients and physicians. I can see it now: Hundreds of medical students, nurses, physicians, radiology techs, respiratory therapists and pharmacists, all in multicolored scrubs, together demanding the end of the monopoly of drug trials, televised drug ads and patient satisfaction surveys, and of the hegemony of the C-suite.

They would rave about the influence of business graduates in medical executive boards; against insurance company denials of life-saving procedures and home-health care solutions; and against the annual, 11th hour Medicare doctor payment fix in favor of a permanent solution, instead of the yearly anxiety caused by this poorly constructed piece of legislation. They would rail against the "hotelization" of hospitals; against turning patients into "consumers"; against the law of diminishing returns of hospitalizations, which holds that the more we do, the better paid we get, regardless of how much of an impact all that "more" has on a patient's health; against the aggressive opposition to higher reimbursement for preventive care and services; and against "cover-your-ass" medicine.

Not going to happen? Yes, you're right. The occupiers have all the time in the world and the irascibility of youth, plus many of them have nothing to lose. And health care workers, you and I, do have something to lose.

But maybe some of that "occupy" mentality can help us focus on the issues that matter in our health care delivery system. Regardless of your opinions of the Patient Protection and Affordable Care Act, the fact is that year after year we, the health care workers, let others (for example, the politicians) dictate what's best for our patients and us. Our political lethargy stems from the privilege of our position, which we are afraid to lose. It's that constant threat of loss that prevents us from speaking out, from shedding our white coats and becoming occupiers.

In his book "1984," the political philosopher and novelist George Orwell described the power and endurance of the ruling classes with the tenet, "Who wields power is not important, provided the hierarchical structure remains always the same." The Occupy Wall Street movement aims to upend the economic hierarchical structure of capitalism. Can we do the same and try and take the reins of our health care future?

If so, I will gladly house the occupiers in my call room. After all, it is the Holiday season. And it's getting cold outside.

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3 Comment(s)

Jack Percelay wrote:
Interesting paradigm. As a pediatric hospitalist living in NYC where we have many neighbors who are "in finance" or otherwise striving to become part of the 1%, I have a little different take.

I am @#$@#$*&!! angry that purportedly knowledgeable MBAs in big firms allowed the mortgages to get completely out of control. Remember the "no doc" loans? Didn't take an expert to see that this was going to fall apart, a house of cards so to say. Wall Streeters had an ethical obligation to let us know the system was going to collapse.

I am tempted to cast out the first stone, but we physicians live in glass houses. Our current health care system is unsustainable. The status quo isn't. The solutions aren't obvious, the choices aren't easy, but we certainly need to occupy the public debate in a responsible manner. Finger pointing after the collapse serves no one well. Thanks for encouraging dialogue.
New York, NY | Wed, Dec 21 2011 14:33 PM

Jeffrey Bennett wrote:
Rock on! I'm seeing promising signs that physicians are infiltrating the hierarchy, and thus remain hopeful that the paradigm will shift toward adding value by promoting and preserving health.

The hospitalist movement is, in part, developing a generation of "insiders" who are trained in systems thinking. It strikes me that the more sophisticated we become in understanding the interrelationships between the various medical structures (including payer systems), the more frustrated we become --
and the more engaged! Will more physicians run for national office? Will more become CEO's of hospital systems? Dare I think that health care policy will be written by health care people? The occupation has already started, and maybe it will help. Thanks for the excellent blog.
Lexington, KY | Thu, Dec 22 2011 20:19 PM

Ruben Nazario wrote:
Jack and Jeff,
I certainly see the frustration every day with our health care system, just as both of you do, and I do see a glimmer of hope in that we have more and more physicians occupying the administrative areas that were once the exclusive domain of nonclinical administrators.

I hope that we can do so, like Jack says, in a "responsible manner." I still think that we need to occupy more of the political debate that sometimes seems so out of our reach, with our fragmented political representation. Only then, like Jeff says, will we have doctors (and nurses, and other health providers) writing health policy "by the health people, for the health people and patients." Thanks for your opinions and your encouragement!
Fairfax, VA | Tue, Dec 27 2011 11:21 AM

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About Ruben J. Nazario, MD
Ruben J. Nazario, MD, is now medical director at Inovalon, a health care data analytics company, and is medical editor for Elsevier's First Consult. A pediatric hospitalist, Dr. Nazario is a veteran of both community and academic pediatric hospitalist programs. All material represents his own views and does not reflect the views of his employer.
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