I have never contended that histotechs don't care about patients. It would
be silly for me to assume what any particular person thought about the
matter without asking that individual. What prompted my comment was the
thread about what kind of job (Hospital v. Corporation) was better;  I was
disturbed that the PURPOSE of each type of job was not being considered.

Okay, THIS is what I believe as of August 24, 2001, 2PM. I am always willing
to change my beliefs as my understanding of the universe arounds me becomes
more complete. 

1- The practice of medicine for the primary purpose of making profit is
unethical. This is because the relationship between doctor and patient is
one based on trust. The patient asks the doctor for his advice and the
doctor acts in the interest of the patient and not his own financial
interest. It is the patients responsibiity to see that the doctor is
compensated for this activity (unless the doctor knows he is giving
charity). I make a good living because I believe I provide a valuable
service AND because I have the means to pay myself well while simultaneously
providing excellent laboratory services. Patients and insurance companies
pay me to do what I do. I am very fortunate (blessed even)to be in such a
situation. Many folk love what they do, but do not have the opportunity to
be so well compensated for it.

2- Medical corporations may behave ethically when the stockholders are
medical professionals who believe in the fiduciary relationship above.
Because people who are not medical professionals may hold these same
beliefs, if is possible that non-medical investors can be an ethical part of
a medical corporation. Unfortunately, I believe this is rare and that such
organizations, especially as they get larger, are particularly prone to
shift towards a mission of profit rather than patient care. Publicly-traded
corporations are especially prone to pervert the medical purpose of the
enterprise. I have addressed this problem in my own practice by financing it
myself and not having any external or non-medical investors. No one demands
a return on their dollar. The salary I pay myself and the joy I receive in
practicing my profession is more reward than I need.

3- Histotechnologists are a vital part in patient care and should be
responsible not only to their employer, but most importantly to the patients
they serve. It is their responsibility to let their employers/ supervisors
know what is necessary to do their jobs appropriately, whether it be proper
reagents, equipment, additonal staffing or compensation. While the legal
responsibility currently falls on the pathologist/ hospital, it is the
ethical responsibility of the histotech to let all responsible parties know
what is required for proper patient care and when those minimum requirements
are not met, how to attain them. Unfortunately, it is the pathologist who,
while legally and ethically responsible, may not be politically willing to
take on this task. If pathologists are owners of the laboratory, they may
not be willing to reduce their incomes in order to improve patient care
(Shame on them!). If proper care and/or compensation cannot be achieved
after all reasonable attempts, the histotech owes it to him/herself to seek
other opportunities elsewhere. On the other hand, the histotech who hangs in
there in times of financial hardship and persists in spite of their being no
hope of relief is a hero, perhaps somewhat stupid, but a true hero
nonetheless. One the other hand, sometimes the only way a histotech may be
able to bring insight to lab administrators is by leaving.

I welcome your comments and criticism.

Jonathan Oppenheimer, MD
Pathologist,
OUR Lab, Nashville, TN

-----Original Message-----
From: Jasper, Thomas [mailto:TJasper@smdc.org]
Sent: Friday, August 24, 2001 6:15 PM
To: 'histonet@pathology.swmed.edu'
Subject: hosp v corp response to Dr. Oppenheimer


>>>Dr. Oppenheimer, what do you think...perhaps nurses aren't concerned
about patients because they have the most powerful unions in healthcare and
all they worry about are their wages and benefits?! Think about it. I
realize that pathologists are the ones carrying the legal responsibility
etc., but don't shoot from the hip about histotechs discussing the pros and
cons of clinical vs corporate settings and attribute it to a lack of concern
for patients!