A Secret Playbook to Torment Doctors

flying cadeuciiA physician friend commented recently that he was being ‘meeting-ed to death’ and wondered if it was intentional. It turns out, he was on to something.

One of my colleagues has a neighbor whose sister’s piano tuner has a friend whose cousin is married to a nationally respected medical institution’s CEO. We were provided a copy of that institution’s management training course, on the condition that her identity not be revealed.

Here is the section on meetings:

Meetings as a Tool for Physician Control

Meetings are the ideal method for turning actively engaged and therefore troublesome physicians into apathetic sheep who are easy to manage.

Unhappy physicians may whine and complain, and are a problem for morale, but this is far better than having to deal with a group of spirited and independently thinking, highly educated, and passionately motivated physicians who want the institution to focus on patient care rather than on administrative issues like regulatory compliance, billing, or data collection.

If physicians can be forced to interact with management and leadership only in small and isolated meetings, and if the other management practices taught in this course are in place (information is locked into silos, there are effective barriers to communication, intimidation is used as a response to criticism), physicians who are inherently motivated and trained at both data analysis and problem solving will be unable to coalesce and help steer the organization. This leaves management in the position of making all decisions with little risk of effective clinical input.

The negative impact of meetings on morale can certainly impair productivity and revenue, but this is easily addressed with pay-for-performance targets and withholds. This is easier, of course, if the P4P system is complex and opaque, making it impossible for physicians to verify the accuracy of your data. (This principle applies across the board. Transparency is your enemy. They can’t complain effectively about what they can’t find or understand.)

Whenever possible, respond to every issue, question or request for information with the suggestion that ‘we should schedule a meeting’ with no further details. Best practices for this approach include:

  • Schedule it at a time that conflicts with patient care. (Extra points if it requires driving to a different location.)
  • Do not describe any concrete goals for the meeting and do not provide an agenda in advance. Make sure you know in advance what you want the meeting to decide. If it appears it will not give the desired result, manipulate the meeting to require further meetings before a decision is made. It is hard for participants to consider a meeting a failure if you can re-define its purpose after the fact.
  • Do not provide any materials to review in advance. This is especially important if the meeting was scheduled in response to a request for information. Physicians are trained in science. They will be unable to resist the temptation to evaluate the validity of the information, and may even present other information that might call your plan into question. Evidence-based decision making is only safe to the extent that you can define what evidence is used.
  • Make sure that some of the key stakeholders are not invited, or are invited too late to be able to attend. This is key, as it makes it impossible to make quality decisions at the meeting and leads to future meetings. (If different people are missing at each meeting, it may be possible to perpetuate inaction through continued meetings for an indefinite period.)
  • Make sure that there is no general awareness of the issue among your physicians. Engagement is contagious, and the last thing you want is to spread the ‘disease’ of collaborative decision making.
  • As a corollary, make it hard for participants at the meeting to interact and collaborate outside the meting. The importance of barriers to communication is covered in depth in the section: “Communication: Silence is Golden.”
  • When preparing the minutes, simply list the items on the agenda and note whether or not they were discussed. It is acceptable to refer to distributed packets or other information, so long as it is done in a way that the reader of the minutes cannot actually access the information. Make any conclusions or decisions as vague as possible. (See the Appendix entitled: “Safety in Minutes: Less is More.”) The less information, the better. You want to avoid being held accountable for what is in the minutes, and truly informative minutes can obviate the need for future meetings.
  • When the minutes are completed, circulate them only to the participants at the meeting. Do not make them available to other stakeholders or archive them in a user-friendly system for future reference. Even if they have been seriously Bowdlerized and contain little information, there is a risk you will be held accountable, and it is easier to respond multiple times to the same questions and issues with the ‘Let’s have a Meeting’ ploy if the record of previous meetings is not available.

8 replies »

  1. True enough though understated compared to the non-documented discussions that occur in the adminstrators offices and closed meetings.
    Whether satire or not this is pretty much the way it has been working for far too long. The world of industry has it’s undesirables (‘whistle blowers’).
    In healthcare we call them ‘disruptive physicians’ and start documenting ‘behaviors’ much like an HR department readies it’s staff to fire someone while shoring up full anorectal protection.

  2. Dr. Elias thank you for this exceptionally entertaining satire. It is not only clever and right on the money, but it is hilarious as well. Keep it coming!

  3. You would think that such a cunning and devious mind would not put its handiwork in writing.

    I have seen about the same nasty hijinx in my hospital. The docs need a course in street smarts. Our docs owned our hospital–it was a membership corporation–and they gradually and incrementally gave up this ownership over twenty years to management.

    Evolution does not treat this type of adaptation well.

  4. Any physician who volunteers to work in a system like this and continues to attend these meetings (however satirical the description may be) deserves what they get.