This State of Affairs Cannot Be Allowed to Continue
The editors deserve thanks for giving space to a subject that is often brushed under the carpet in public statements and by doctors’ representatives and healthcare politicians, and thereby placing it on a rational footing: the increasing—and in my opinion—now unacceptable commercialization of hospital medicine. The results of the study reported by Wehkamp and Naegler (1) do not come as a surprise to insiders—and neither does the fact that the study was privately funded by the authors (see conflict of interest in the small print).
Every single medical director who works outside the university setting in Germany today will be able to confirm the “economic reasons” from his or her own bitter experience.
For myself (I have thankfully now reached retirement age) I can say that I was the medical director in different municipal and confessional hospitals between 1997 and 2013, and I can only underline the conclusion by Köbberling in his editorial (2): “This state of affairs cannot be allowed to continue!” Not only politicians, but also organized doctors cannot close their eyes to this obvious conflict.
We older doctors have internalized the principle “salus aegroti suprema lex” [the sick person’s wellbeing is our highest law], as taught by our academic teachers. If we don’t call for critical discourse, then who will? The next generation, which will have grown up in the era of diagnosis related groups (DRGs), are not going to. To the detriment of the patients—today’s patients and future ones.
At the human and personal level, it is quite understandable that a medical director who is still active will keep quiet in case of doubt, because for some doctors, broaching the problems openly would be connected with economic risks. This is a polite way of expressing the issue, but it describes precisely what’s at the heart of the medical problem.
Prof. Dr. med. Ulrich Krause
|1.||Wehkamp KH, Naegler H: The commercialization of patient-related decision-making in hospitals—a qualitative study of the perceptions of doctors and chief executive officers. Dtsch Arztebl Int 2017; 114: 797–804 VOLLTEXT|
|2.||Köbberling J: Economic pressure in hospitals—profound disagreement over priorities between doctors and managers. Dtsch Arztebl Int 2017; 114: 795–6 VOLLTEXT|