Doctors governed by authoritarian systems that compromised care

The United States is a democracy. However, most US medical centers are governed more like dictatorships. Doctors do not elect their leadership. In fact, their leadership is often selected by a few select individuals appointed by the hospitals. This allows hospitals to hire and control doctors. Many states had realize this conflict and therefore have laws that forbid hiring and control doctors. These hospitals get around these laws by controlling physician medical practices. These doctors practices hire the doctors directly but are controlled by a physician controlled by the hospital. Unfortunately, given how medical care in many regions are controlled by a few medical centers, doctors have little choice except to work for these large networks. But the doctors have little decision making power. The policies are decided by hospitals and enforced through the appointed physician leader of the medical practice.

Doctors then are afraid to speak up for fear of retribution. For example, one neurosurgery chief had botched a procedure. The neurosurgery chief was a spine neurosurgeon and does not routinely perform brain neurosurgery. Spine neurosurgeons do not feel comfortable performing brain operations and vice versa where brain neurosurgeons do not feel comfortable performing spine operations. However, there was a need for an emergent brain operations in the middle of the night. The neurosurgery chief performed an inadequate operation and did not remove the brain vascular malformation with the hematoma. However, he prevented the brain neurosurgeon the performing the proper operation the following morning. The neurosurgery chief did not want to look bad. The patient died a few days later from the rebleeding of the vascular malformation.

The neurosurgery chief may have swallowed his pride is the patient was not black. Certain demographics received worse case. Since the patient was black, the neurosurgery chief did not think she or her son would push for investigation. When she died, the neurosurgery chief told the son, he did everything possible. That was obviously not the case.