Straight Talk - "Three primary themes"

January 16, 2014

Dear Friends and Colleagues,

Many (too many!) years ago, after I graduated from the College of Physicians and Surgeons of Columbia University and as an impressionable medical intern at Columbia Presbyterian Medical Center, a very wise, senior professor of clinical medicine pulled me aside and conveyed a most memorable piece of advice: “Just care for the patient and everything else will follow.”

Today, 40 years later, that counsel still holds true. Caring for patients and putting patients’ interests ahead of our own remain two fundamental ethical principles inculcated into every new physician. As we graduate from medical school and become professionals, we take the Oath of Hippocrates or the Oath of Maimonides, both of which have professional ethics as their essence.

In recent years, sadly, regulatory authorities have reminded us that there are other not-so-noble motivations sometimes afoot in healthcare. They are damaging to everyone—patients, payers (insurance companies, particularly Medicare), physicians, healthcare systems, and the general public. These questionable motivations lead to abuses and overutilization.

So it is more important than ever to remind ourselves that the three primary themes that have sustained our profession over time—medical ethics, transparency, and caring for the defenseless patient—need to be reemphasized; especially as we respond to an increasingly competitive global healthcare economy. Observing and practicing these three practices will benefit all participants in the healthcare system. Here’s how we are approaching these imperatives as a system.

  • Medical ethics. Our goal at NCH is to help people live longer, happier, and healthier lives. We and our colleagues in not-for-profit healthcare systems are conscientiously trying to keep people out of the hospital. Ultimately we want to evolve from a “repair shop” mentality to a prevention community. Toward this end, among other initiatives, we operate two state of the art Wellness Centers; have asked our own 5,600 colleagues and families, for whom we provide health insurance, to embrace a Road to Wellness to instill healthy behavior in our everyday lives; and we are embracing a Blue Zone Initiative to add years of life expectancy for all of us in the community.

  • Transparency. The digital age is here to stay. Having ready access to information about quality, cost, and overall value enables patients to become wiser and more sophisticated in their healthcare options. This trend is good for everyone. The more we know, the better we will do. The payers also have more information and better analytics than ever before and should be using this knowledge to direct patients they insure to physicians and healthcare systems which provide “high value,” which is what we seek at NCH.

  • Patient care. We should all understand that as caregivers, we are judged by the company we keep. We profit from being associated with ethical, principled, honorable organizations which do the right thing to get the best results for patients. NCH has served our community for nearly six decades, has been governed by a community board responsible to the community, and has never succumbed to enticing acquisition overtures from for-profit companies. We prefer to remain independent and local to best serve our patients, our neighbors.

We are not immune to mistakes; no individual is perfect. But we will not be driven by self-interest, by placing economic incentives ahead of serving our patients’ best interests. Our challenge is heightened by the inexorable trend in healthcare to pay for “value,” not volume. Our loyalty is to our community, and our mission lies in the bedrock principles we learned coming out of medical school. We are here to help our community’s citizens live longer, happier, and healthier lives. That is a pledge we don’t intend to break.


Allen S. Weiss, M.D., President and CEO

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