Sunday, April 24, 2016


There are the Kings and Queens, Bishops and Knights cornered by the Rooks. All are protected by the Pawns that line up in front to spill their blood in allegiance. A game of strategy, deception and aggression is in play.

But what of the Pawns?

Pushed from the rear in a single step, sometimes in deception and other times as defense, the Pawns ride the crest of the oncoming slaughter from the Bishops, Knights, Rooks and especially the unfathomable actions of the Queen. She lurks stealthily behind a facade to deceive and obfuscate the real desire of bringing the opposing King to his knees while her Lord remains quietly “Castled” behind in the protectorate. She is cunning, crafty and deceptive, she uses her Bishops and Knights to set up the Rooks in cornering the King while with equal aplomb arresting the equally devious opposing Queen. Whose charm and alacrity will win the day is anyone’s guess. But in this deep dark world of war blood is spilt and it rarely is the Queen or the King, who quietly surrender, but of the lowly pawns, the Bishops, Knights and the Rooks. Victory is pyrrhic under most circumstance. The waste of life is pronounced as Victory. The vanquished and sometime the victor are left with no armies to speak of. And therein lies the Art of War.

We are all Pawns in this game being played at higher levels. Crafted in the tidy epicenters of power the players sip on expensive wine, bid on barren canvases, satiate their desires on aged cheese while the war goes on with each move of the Pawn. They smother their squeals of laughter when deception wins and kick down the opposing Pawn in abject condescension. Such is the game that lays bare the inner desires of warring factions that stride to win at all costs.

Such is the case when a non medical self-styled intellectual becomes the boss? Actually in more ways then one. A CEO of a hospital makes “rounds” around the hospital spewing euphemisms and pleasantries while in the Board Room he or she is exhaling fiery breaths. The “revenues” are down and heads must fall. “Find the doctors that are costing the system and furnish them with threats and reprisals.” “Cut some of the ancillary staff; maybe transporters, aides and the like.” The sentences barked in extreme condescension bear little evidence to the smiling exterior that meanders the corridors. His main purpose is to increase the bottom line. His main purpose is to enhance the image and hope for a merger with a bigger hospital where he can gain a seat of power and continue the climb to even better prosperity for the self. After all isn't it always the self that a business person strives for? Of course it is. Even an accountant who finds such easy low-lying fruit is going to have a field day picking. One such personality is alleged to have done some real nasty stuff to the hospice patients to increase his bottom-line. This behavior is inhuman in a lot of respects, but if we are true to ourselves, we might find that the current push for limiting care because of costs sets up this kind of a mindset. Doesn’t it? Think about that for a bit.

Physicians have little say in the matter when it comes to the high and mighty business-mettle, hard-hitting, fierce -bottom-line protector CEOs. Patient care is exported to some ethereal realm. The only purpose is to fill the beds and empty them as soon as possible irrespective of the patient needs. The zeitgeist is how a hotel is evaluated by the shareholders by per room occupancy or an airline is viewed per passenger mile.

So pawns we are, as physicians, to the business minded Kings and Queens that populate and copulate within the halls of power and make policies to govern other’s behaviors to improve the bottom-lines.

Someday the White Knight will find a backbone and together with the White Queen will decimate the Maleficent dark enemies and her armies of bean counters. Someday the Pawns will rise up and gain their respect for all the daily wonders they accomplish. Someday patient care will be true patient care and not one made up of false statistical premises and arbitrary and capricious guidelines based on costs. Someday the King and Queen will have climbed the ladder of true knowledge and wisdom of medicine and become the arbiters of goodness and not grief.

Some day…

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