Castlen Joseph P, Cote David J, Moojen Wouter A, Robe Pierre A, Balak Naci, Brennum Jannick, Ammirati Mario, Mathiesen Tiit, Broekman Marike L D
Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Neurosurgery Department, The Haga Teaching Hospital, The Hague, Haaglanden Medical Center, The Hague, Leiden University Medical Center, Leiden, The Netherlands.
World Neurosurg. 2017 Jun;102:420-424. doi: 10.1016/j.wneu.2017.03.073. Epub 2017 Mar 24.
Medicine is rapidly changing, both in the level of collective medical knowledge and in how it is being delivered. The increased presence of administrators in hospitals helps to facilitate these changes and ease administrative workloads on physicians; however, tensions sometimes form between physicians and administrators.
This situation is based on perceptions from both sides that physicians obstruct cost-saving measures and administrators put profits before patients. In reality, increasing patient populations and changes in health care are necessitating action by hospitals to prevent excessive spending as health care systems become larger and more difficult to manage. Recognizing the cause of changes in health care, which do not always originate with physicians and administrators, along with implementing changes in hospitals such as increased physician leadership, could help to ease tensions and promote a more collaborative atmosphere. Ethically, there is a need to preserve physician autonomy, which is a tenet of medical professionalism, and a need to rein in spending costs and ensure that patients receive the best possible care.
Physicians and administrators both need to have a well-developed personal ethic to achieve these goals. Physicians need be allowed to retain relative autonomy over their practices as they support and participate in administrator-led efforts toward distributive justice.
医学正在迅速变化,无论是在集体医学知识水平方面,还是在其提供方式方面。医院管理人员数量的增加有助于推动这些变化,并减轻医生的行政工作量;然而,医生和管理人员之间有时会产生矛盾。
这种情况基于双方的认知,即医生阻碍成本节约措施,而管理人员将利润置于患者之上。实际上,随着患者数量的增加以及医疗保健的变化,医院有必要采取行动以防止过度支出,因为医疗保健系统变得越来越庞大且难以管理。认识到医疗保健变化的原因(这些变化并不总是由医生和管理人员引起的),同时在医院实施诸如增加医生领导力等变革,有助于缓解矛盾并营造更具协作性的氛围。从伦理上讲,有必要维护医生的自主权,这是医学专业精神的一项原则,同时也有必要控制支出成本并确保患者获得尽可能好的护理。
医生和管理人员都需要具备完善的个人伦理道德才能实现这些目标。在医生支持并参与管理人员主导的实现分配正义的努力过程中,应允许他们在实践中保持相对的自主权。