A relationship in need of critical care

I've been here at FierceHealthcare less than a month. But it was only a matter of days before signs of a fault line between doctors and hospitals began to appear in comments. They were reacting to something I'd written on our website about how better communication between hospital leaders and physicians could promote patient safety.

Those who wrote in sounded grim to pessimistic about the doctor/hospital relationship.

After reading how the Joint Commission has charged leaders with creating and carrying out a process for managing disruptive and inappropriate behaviors, one commenter wrote, "What a joke." The remark seems to reflect a certain amount of cynicism related to hospital leaders' ability to manage poor behavior.

A voice from the physician side shared a survival technique for dealing with hospital administrators. The best communication is "to ignore them completely and focus on patient's care," the poster wrote. "Unfortunately employed doctors are beholden to these rascals."

"Doctors are nuts to work in hospitals," another wrote.

What's going on here? When I hear comments like these, it's clear something is broken. These are provocative comments, given how many doctors are choosing to go on staff, opting for security over autonomy.

A Baltimore-based GI doctor who read some of the comments told me they weren't surprising at all. Here's a common scenario, he said: A patient was 5 feet, 2 inches tall and weighed 230 pounds. She came in for a colonoscopy. Because the patient had hypertension and diabetes, the doctor had to order an EKG and contact a cardiologist. He was already running an hour behind.

That day, when he received the quality manager's memo that said they couldn't read his signature, it was like a message from another galaxy.

His reaction?

"Oh Christ," he says. "Keep those people away from me. They have no idea what I deal with everyday."

Stories like these give me pause. When doctors perceive hospital managers at best as an irritant to be ignored or brushed away and at worst as an obstacle to care, something is wrong with physician/hospital relationships. It's as if physicians and hospital leaders inhabit separate worlds. And it's hurting patient care.

What's your take? Is this an accurate diagnosis? I'd like to hear from doctors and hospital leaders who can recommend ways hospitals can promote more productive working relationships with physicians. What, if anything, has worked for you? And what hasn't? - Sandra