Your care is in the hands of the weakest link of the hospital team. When you go to a hospital, bring a friend. In today’s environment, with severe hospital cuts in personnel and budget constraints, you must constantly be alert and ask questions. Despite trusting your doctor implicitly, you must realize your care is in the hands of the weakest link of the hospital healthcare team. Currently this team has difficulty running efficiently.

Layoffs of nurses and staff are common these days. This has resulted in poor patient care. Services must now provide optimal returns, and hospitals have developed strategic financial and operating plans. Power, control, and money make it difficult for inter-disciplinary teamwork, and optimal performance.

Doctors are seized by fear their medical reputation will be in jeopardy by poor patient medical care. Hospital personnel must improve their efficiency, but their pay is based on incentive performances.

Nonprofit hospitals and healthcare systems are looking for mergers, affiliations, and joint ventures with competing hospitals and large physician entrepreneur groups. They are now forced to avoid both public and regulatory relations risks and also make big deals to keep financially solvent.

Healthcare reforms are now in charge of new politicians and regulators. To find solutions for survival, hospital administrators are twisting the arms of department heads to cut medical costs. Clinical services are daily evaluated on their reimbursement value to justify their existence. In view of the new political framework, hospitals find it hard to evaluate the economic viability of services they now offer.

The new Obama-Care government is not kind to hospital business as usual. They are constantly shaping health care from a technological, financial, and epidemiological framework.

New hospital staffs are being formed, from a group of professionals that are interested in promoting and improving fractured care at their hospital, from a collection of independent, employee, and contracted physician groups. Cultural barriers between these groups, has in the past created inertia.


Be aware that a non- emergency procedure that starts after routine business hours has a great risk of complications. Weekend admissions are also death risk factors. Evening and nighttime hours have shown an increased death risk also in intensive care units.

On weekends compared to weekdays, because of staff fatigue, and part-time medical and nursing staff shortages, your medical risks dramatically increase. Studies show 46% of harmful events are associated with an operation at that time. (ANNALS OF SURGERY 4.30.08)

Very few surgeons are available for operations that come from the emergency room, resulting in long waits for emergency and elective general surgery. (It is estimated that the surgical work force will produce only 145 new surgeons each year for the entire country.) This is caused by the fact that most doctors now specialize in vascular or thoracic surgery. Having taken medical student loans of $150,000, and working as residents for 40,000 a year for 3 to 7 years before they become board-certified, they find it financially more rewarding than working an unmanageable 80-hour week

This has resulted in a specialist for every part of your anatomy, all-specializing in one organ. This has resulted in no one doctor in charge to coordinate all of your medical needs. Doctors have become part of a hospital machine that is cold and uncompassionate.

As you follow medical developments through the media, you realize you no longer can accept any medical decisions without questioning them. Many times, you are disappointed because, your doctor has never heard about breakthroughs and certainly is not as excited about your new information as you are. How willing he is to have a dialogue with you, tells you how willing he will be to successfully treat you medically.


It is normal for your body to heal itself without a doctor. Hippocrates believed it was better to avoid any treatment that might cause harm or that would interfere with the healing process. Your welfare was always a priority and your state of mind was found important for a successful medical treatment. The art of science and medicine go hand-in-hand, and can’t be divided.

Are you ready to accept and embrace the realities of Obama care reform? Will you refuse to adhere to the findings that cheaper drugs work as well as more expensive drugs, or sue doctors who try to do so?

Doctors believe they are superior to you because of their training, licensure, or prescription drug laws. What is the doctor to do, when you demand an antibiotic for a cold or your child’s ear infection? If you demand an MRI for your back pain or knee pain, and your doctor refuses, will you call your lawyer that afternoon? Ultimately doctors are the only ones responsible to order antibiotics or MRIs. Every decision a doctor now, will makes him subject to the threat of malpractice.

It’s fine to suddenly have comparative effectiveness research costing billions of dollars, but if the doctor and you don’t abide by those findings, all this money goes down the drain.


Both doctors and patients are going to have to accept changes. All of you will need an advocate that will encourage you, the patient, to exercise, eat healthy foods, listen, write stuff down, ask the doctor/nurse questions about things they don’t understand, question rationale for a treatment, understand follow up treatment, tell the doctor if they can’t afford something, or ask the doctor for a more affordable option or alternative.

Most0f you will accept a doctor’s opinion, if he explains his thinking. It’s always been easier for him to write down the drug on a piece of paper and run out of the room, then deal with your pesky questions. Our government has painted the doctors as obstacles, seen as enemies to be crushed. Doctors have lost the art of communicating and must get it back fast.

As we evaluate the new “evidence-based medicine”, that have recently changed medical guidelines, doctors must examine the underlying data, the assumptions, and the motivations, (cost containment) that result in their conclusions.

The new guidelines do not define the standard of medical care. The medical profession, collectively, must decide the standards of care, and provide testimony to that in a court of law.

Doctors, as well as hospitals, must now be trained into the business of medicine, including the very important skill of coding. Nurses, on the hospital ward, now sit at computers and translate every medical diagnosis into a five-digit number, with an additional number to explain the type of work done for the patient. There are inevitable mistakes that lead to non-payment, because of inaccuracies of medical conditions, and some diagnoses not having diagnostic codes.

Your treatment now need pre-authorizations, and have innumerable restrictions placed on them, Medicare has placed great paperwork requirements that obstruct good medical care. Meanwhile, your care is withheld.

The next time you visit a hospital, check what the nurse and clerks are doing. They are not helping your loved one, but are filling out all important government paperwork on their computers.