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Message: <blockquote data-quote="C_Hallbert" data-source="post: 4234060" data-attributes="member: 42957">My personal opinion:I worked as a hospital based ‘Registered Respiratory Therapist for 39 years (last 31 in Oklahoma) with my final 24 years as the technical Director of Respiratory Care Services in cooperation with a physician Medical Director: Respiratory Therapy; Pulmonary Laboratory; Bronchoscopy; Sleep Laboratory; Hazmat and Medical Waste (LOL). During this time, I served 20+ years in Safety, Medicine and Accreditation Committees where I collected and reported my areas' operational data, reviewed medical records, investigated and reported variances in patient care. Routine patient care under my direction involved: administration and documentation of respiratory medications oxygen and mixed medical gases; set-up, operation, documentation, disinfection and maintenance of mechanical ventilators in the ICU, ER and Neonatal ICU; emergency manual resuscitation; CPR; and chest physiotherapy. During this career (I loved my work), I observed numerous drastic and detrimental changes in our country’s healthcare system. I'll try to enumerate: intrusion in patient care processes between physicians and their patients by Federal (CMO), State Agencies (State Department of Health); Health Maintenance Organizations (HMOs); Preferred Provider Organizations (PPOs); Hospitals and Medical Clinics; Health and Liability Insurance Corporations; JCAHO (Joint Commission on the Accreditation of Hospitals) all purportedly functioning in the best interests of patient care, safety and cost control. All of these entities have aggregately created a disparate constellation of documentation requirements consequent to government regulations; accreditation standards; medicare/medicaid reimbursement requirements; insurance allowances and reimbursement rates; insurance liability demands with individual institutions devising policy guidelines attempting to comply with them all. This situation has created a monstrous bureaucratic minefield where physicians and healthcare workers attempt to provide patient care despite the ridiculous, counterproductive interference.   The conundrum of competing interests that must be served by physicians are so burdensome that individual practices have nearly become extinct causing the majority of doctors to seeking employment from one of the entities listed above. The Employer/Employee Relationship inherently creates an overwhelming influence on physician practices by limiting their income, autonomy and once sacred rights to choose diagnostic procedures, interventions and pharmaceuticals they believe appropriate for the care of their patients. These agencies and organizations have become more and more prescriptive (controlling) forcing physicians to follow scripted protocols, algorithms and mnemonics, regarding diagnostic, treatment and pharmaceutical options physicians must follow and precluding the off label use of pharmaceuticals empirically demonstrated to perform beneficially in order to remain in compliance and to remain employed. This situation has caused many, many excellent older doctors to retire early.The counterargument supporting these controls on physician practices appears logical. Patient Safety and Peer Reviewed Evidence Based Patient Care Practices sound like they are good things. However, Peer Review is not what it used to be as evidenced by its deliberate misuse in Education, Environmental Science, Anthropology, Atmospherics, Social Services, and most grievously in Medicine during the Coronavirus Panic. The financial and personal interests and political agendas acting in the background all too often shape the methodologies and procedures used in order to produce desired outcomes. The system has been restructured in such a way as to stifle the process of independent discovery outside of the ‘authorized’ large corporate arena. I would much prefer medical care from a wiser, older, more knowledgeable, experienced physician that is free to function without distractions or interference as traditional doctor as opposed to the servant of a committee comprised of conflicted masters. I believe that the significant majority of physicians are excellent, trustworthy people whom are trying to function in a complex, ever-changing environment. However, I also believe that the selection, education and training of physicians as it has evolved do not come near to producing the quality of these professionals as they once did; and, I firmly believe an individual's ability, not equal opportunity, should be the only criteria for selection.</blockquote>

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