It’s natural, as we get older, to yearn for times past—times that we remember to be better than the present.

Quality of service comes to mind right away. I told my kids that you could once talk to a human being who lives in this hemisphere when calling for customer service. They looked at me, wide eyed, like I told them we had an outhouse when I was their age.

The ability to alienate the medical staff seems to be a prerequisite for promotion in many hospital systems.

Many things in our lives, of course, are much better now; but we forget these things in moments of frustration. It’s hard to remember when there were no ATMs, cell phones, or computers. It wasn’t all that long ago that childhood leukemia usually resulted in death, people of color were segregated in public, and the Cuyahoga River caught on fire. All in all, I’d say that things are much better now than they were when I graduated from high school thirty-some years ago.

What is written hereafter requires a caveat. These words are in no way a commentary on my particular hospital or employer but a commentary on hospitals in general. (I do still have to put food on the table, don’t you know.)

The management and culture of our nation’s hospitals has changed dramatically over the past 20 years, and I find myself longing for the days when there was no health care “industry.”

It used to be easy to tell the difference between the for-profit and the not-for-profit hospitals. You could almost smell it when you walked in. There was a sense of togetherness and dedication in the not-for-profits that you didn’t find anywhere else. Now you need to look at a tax return to tell the difference.

There was a time when the CEO of a hospital lived and died by his or her relationship with the medical staff. CEOs who consistently antagonized the medical staff found themselves working in the men’s department at Sears. Just the thought of some of these weasels pushing cheap suits makes me smile. Now, the ability to alienate the medical staff seems to be a prerequisite for promotion in many hospital systems.

If the CEO can please the insurance companies, he can practically flip off the medical staff on the way to collecting a six-figure bonus. When is the last time your CEO spent any time in your department cultivating a relationship with you? A lot of these guys can’t find their way to the ED without help, anyway (“So, this is that place they keep complaining about…”).