Sunday, February 24, 2013

The NEW Value Chain in Medicine

( A thinking person's landscape of the current DSS (Decision Support System) in Medicine! )

Diseases are wrapped in the human shell. The upstream is the collective whips and scorns of time; the lifestyles of smoking, drinking, excess eating and lounging, all abuses of the norm. The upstream catalogs the slings and arrows. It harbors the time afforded decay. It is the repository of the vices and the occasional nature’s sideswipe of misfortune.

The downstream is the processed collections of remedied individuals. Their diseases discarded; a virtual memory buried in the depths to keep the psychical trauma from reemerging and whisking away joy. The downstream has its rudiments of unsound or unresponsive processes that share the scattered and tattered remains, the broken but whole, the hidden but scarred, the scattered temperaments of volatility, the shards that prick and burst any joys of the present. But mostly through all that, there are the large numbers of joyous lights that glow.

Somewhere in the middle between the two streams, are the Processing plants. The shiny, white truths of reality. Somewhere in the vast landscape are the thousands of minds striving to make sense of life’s perilous journey. Somewhere, where the nights and days merge into a blur of grey. Somewhere where time lapsed moments of truths are reminders that this beautiful symphony has many broken strings of dissonance. Where sleep comes on a wink and the constant barrage of demand is a deep flowing river, in there somewhere, are the physicians, toiling to the demands of the hour. Bereft of those moments of recognition, of acceptance, of truths, their lives virtually have faded into the treadmill of perpetuity. That grey has lost its tones. In the dark quarters of these dungeons the physicians continue to slave away,  they are likened to the Morlocks by the lever-controlling elite, angered in their frustrations and looking for a way out.

Past the downstream flow is the Assessment and Evaluation station that periodically churns and learns from the information contained within this stream. Some processors are pardoned and others are punished, based on the visible array presenting to those that control the levers of the flow. These evaluators multiply in numbers from the self-ratified and self-confirming excess needs. They create the cornerstones and landmarks for others to circumnavigate. These landmarks are landmines created from a prejudicial, selected bias based on any number of reasons. The current throw rug of comfort is the cost factor. Any process with even an optimal result, mush less a suboptimal one, which everyone would concede, is subject to the coffee grinder of fiscal truth, which leads to the virtual “head on a tall stick.” Expense has become the arbiter and not the byproduct of the process.

Reflecting on the entire value-chain of medicine, one finds the Elves have been replaced by Grinches. Where the onerous weight falls is not in the processing itself but in the cost-controlling industries of self-interests.

Anyway life has changed and it needs to be changed again for the better. The polish on this paradigm has faded, exposing the naked reality.

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