Hospitals have convinced doctors and the public that getting larger is more efficient. Many of our local hospitals are selling themselves to large hospital systems, telling the medical staff that service to them and their patients will be just as personal. Others are just getting larger under the name of efficiency and improved ability to compete. But what is being said and the effect on patient care may be disastrously different.

In our community, eight hospitals have become a two-hospital system of 5 and 3. In addition to the obvious efficiencies of larger purchasing power, the other so-called benefits may not be beneficial. For example, the medical staff services and medical transcription has been consolidated for all five hospitals in one system. Can you imagine how frightening it is to walk into your own medical staff office and no one knows you in the very institution in which you make a living? This can be horrifying.

Also, the five transcription services consolidated to an off-sight contract service. This may make the patient’s history and physical report, the basis for the entire medical record, totally irrelevant. My first transcription to an off-sight transcription pool was totally unrecognizable, both to doctor and patient. It was the type of thing that occurs when a legal transcriber fills in for a medical transcriber and the words are unfamiliar. The transcription was on the chart for several days before even I recognized that it might be mine. It served no useful purpose in the care of this patient. It was not corrected during the five-day patient stay. It was still not corrected when the final summary was dictated.

Information is critical for medical decision making of life and death issues and must readily be available. When business decisions are made without medical input, patient care is compromised. We must always be on guard.