The study reveals for the first time the extent of game-playing and strategising in hospital settings and raises questions about whether patients are treated on the basis of need or on the strength of doctors’ bargaining skills.
“Everyone’s got something to sell and emergency clinicians are no exception. Who’s buying? The answer is the rest of the hospital,” says health care sociologist and study author, Dr Peter Nugus.
“Hospitals are bureaucratic organisations loosely based around the organs of the body. With beds in short supply, emergency departments need to package patients as attractive propositions to persuade other inpatient or surgical teams to formally admit them under their care.
“They have to figure out who is most likely to consummate the deal and purchase the product,” Dr Nugus says. “The game is to use marketing techniques on those they wish to persuade.”
Inpatient doctors are equally well-versed in the skills of resistance and on-selling. “If the patient fails to appeal to the organ-specific requirements of inpatient teams, they hit a wall in terms of their progress through the hospital,” Dr Nugus says.
The study was carried out by the Centre for Clinical Governance Research at UNSW’s Australian Institute of Health Innovation. A paper outlining the findings appears this month in the Christmas edition of the prestigious British Medical Journal.
While it may not necessarily be a bad thing for doctors to defend boundaries and put their interdepartmental colleagues to the test, the practice raises a number of equity issues.
“This study shows that marketing patients is actually part of real medicine,” Dr Nugus says.
“We need to be up front about these strategies and put guidelines in place to ensure the rules around patient care don’t descend to ‘the law of the jungle’,” he says.
“We are only half-joking when we say there might be a place in medical schools for teaching Selling, Marketing and Packaging 101 to future emergency department physicians, and Negotiating, Resisting, and Reselling 101 to everyone else.”
Also contributing to the paper were: Professor Jeffrey Braithwaite, Director of the Australian Institute of Health Innovation; and Senior Research Fellow Jackie Bridges, from the School of Community and Health Sciences, City University London.
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