Saturday, February 7, 2015


Can you dictate the curve of a banana? Can you?

Quite naturally humans have faced threats of great magnitude and survived. They have the unseen instincts and intuition built into the mechanics of reason, which serve them well. The foreboding that comes with such intelligence is amplified via a magnificent brain design. All the peaks and valleys of the sulci and the gyri in the brain beautifully enfold these luxuries of scale in thought and action to prevent harm to self. When illness or a malady visits upon this “quintessence of dust,” there are doctors who stitch and heal the ripped fabric. Were it not for the doctors, human misery would be manifold, survival would still be languishing and the aging demographics would be a distant hope.

But now this enterprise of medicine largely folded into its doppelganger “healthcare” visits its Sister Souljah moment and everyone in the halls of power and control backs away from what was to how it must be. It must be “patient-centered,” they claim. “They are destroying healthcare!” they claim. But who is it that they point to?

That is where we lay our scene…

The Older Past…
Let us look back a few years to see what was. As a patient you went to see your doctor in his office and there were many such tiny little abodes where a single doctor and his army of one would take care of your malady. The doctor would spend time asking about aunt Melody and uncle Arthur and then delve into the rigor of extracting information about health and well-being. He or she would ask several questions about symptoms and signs that you might have observed or seen and any complicating side effects from the medicines previously prescribed and about any improvement in functionality. He would examine with his hands and use his stethoscope to listen to the inner murmurings of the body. Having satisfied himself to understand the problem fully he would pat the shoulders or she would give you a hug of comfort, a word of advice, a wink of understanding and walk with you to the exit. You felt when you left that you had just seen your best friend, most times.

The Old Past…
That lasted a while until the insurance industry and larger corporate types in the business world waddled in with their pendulous money-bags and gold watches tied to their belts. They created a mini-maze of bureaucracy through the HMOs and mandated a clear and unequivocal chain of command for how the doctor would be paid. There were the usual pre-approvals to reckon with, and authorizations to contend with. All in all the bureaucracy was carefully, through incrementalism, comfortably embedded in that tiny little Hobbit sized office. The doctor’s army of one increased to an army of four suddenly with the demands of those times. The doctors concerns about payroll of his employees and his capacity to maintain the level of service was at odds with the demands of the day. Other agencies came visiting and finding faults that had to be reckoned and made compliant, the enormously large volumes of mandates started taking its toll on the beleaguered physician. Now, as the patient entered the doctor’s office that had transformed from a small place to a modern facility of glass, steel and humming electronics, the doctor would say hello to the patient and then with his eye on his watch and one on the waiting room, where many sat fidgeting with their watches or hand bags delayed from their daily lives, sped through the complaints leaving behind a wrinkle of frustration on his or her patient’s brow. The hint of rush was felt within each conversation as interruptions every 18 seconds by the doctor to get to the bottom of the illness’s mystery was all he or she could care about. Time had become a precious commodity.

The New Present…
And if that was not enough, soon the Mack truck of full blown bureaucracy backed into the facility with tomes of “do this for that.” Failure to follow the legal jargon in those tomes, which said much in little, implied more than a lot and warned of a hellish future for noncompliance broke another rung in the ladder of “wellness” afforded to the patient.  There were computers humming in every room of these expanded facilities. The white coat became just that and no more. The doctor was busy looking at the computer as he asked perfunctory questions that were coded by an 18-year old software designer somewhere far away in some far off land to fulfill the desires of an insurer and its governmental agency that existed behind some heavily fortified impenetrable walls. The rush of the action and the patient’s laments were limited to yes and no while the truth of his malady remained entombed within. There was a rush and ruffle of papers handed to the patient and orders to get this and that done before the next visit. The diagnosis and therapy would have to wait until the results poured in later. The Ct scan would diagnose what the hands and critical thinking did before.
The expanded offices could not keep up with the demands of the verbiage. The doctors first tried to add to their staff, failing which they tried to formalize relationships with other doctors into larger networked groups so they could achieve survival through scale. As the demands increased and the rewards diminished many of these organizations failed to comport themselves to live within their contractual obligations. Other doctors left the Hobbit abodes and their expanded versions and sought refuge within the hospitals under the banner of 9-5 jobs.

The Newer Present…
There was a wrinkle on these greener pastures waiting to unfold. The hospitals now emboldened with their own doctor employees were no longer reliant on the community physicians. The hospitals now called the shots. The business-rooted CEOs up-coded their billings to increase their revenues and to increase their bottom lines as the business in the business of medicine slowly corrupted to the core. Meanwhile the CEOs, CMOs, and the CFOs enjoyed the windfall and all made handsome salaries in the 7 digits.  They preached “Do Less with More,” as they cut hospital staff to a minimum and exploited resources that would bring in the highest dollar. The employee-doctors were told how to code for their services, initially this was merely a suggestion and then through verbal force of threats of expulsion from the brotherhood of “providers,” it became the only game in town.  Meanwhile the patients barely saw the physician. The patient care was rapidly evaluated by other less educated individuals whose actions were rubber-stamped by higher authorities. Education was in full bloom, limit costs, abbreviate a trouble life and help a patient die well.

The Newest Present…
Ask your mother or your grandmother in how they perceived their interactions with their physicians then and now and a whole tale will unfold that might sound like a fairy tale. But you should ask, for there is wisdom in a long life! She will tell you that today it is the corrupted influence of inducement, incentivizing and threats that dehumanizes both the patient and the physician.

We are here… and it is today!
What the future holds is cloudy. I predict that once again the undying traits of liberty encoded within the human DNA. One day that small Hobbit-style office will spring back into action with or without the lust for the “global-public-good” decree. After all we are all patients and we will seek what sings to our souls. Patients will demand and the free-market will provide. We will have finally realized the lust to be like Europe! Yet ours will be different, it will not be due to the middling-many, the intermediaries. The favorable doctor-patient relationship will be achieved, through the individualism, liberty and dignity in the end. The old calling “Life Liberty and the Pursuit of Happiness” is also etched in our history’s 239-year old DNA.

No, I don’t believe that you can dictate the curve of a banana. Not just yet anyway! Maybe after sequencing a banana’s DNA we might find the gene that causes the bananas to curve and which can be knocked out to allow bananas to grow straight. Woe to us if we tamper with nature at that level just to prove a point!

Take note, fawners, facilitators and arbitrators!

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