I once had a position in “middle-management.” Never again. That term usually describes a position where you only have the misfortune of delivering bad news from the management above you. They expect you to tell someone that they are a poor employee or deliver the message that they are being terminated but you are never allowed to actually help people become better at their position or be involved in the hiring of their replacement. If you are offered a middle-management position, DON’T TAKE IT!

The same dilemma is occuring in medicine as physicians are being expected to carry out “pathways of care” or prescribe only medicines that are on the insurance company’s “preferred medication list.” It is the physician who has the license to practice medicine; It is the physician who carries the medical malpractice insurance for 6 million dollars; It is the physician who is ultimately held responsible for the life of the patient.

Yet more and more, important medical decisions are being made by government committees and employees of insurance think tanks.  As a physician, remember to hold these “committees” and insurance personnel accountable for their own decisions. I include in my dictation the fact that a pathway of care is being altered or a medication is being rejected by those “authorities” that have taken away my license to practice medicine.  I suggest that you do the same.