"SEND IN THE CLOWNS"

“Where are the clowns?”

“Quick!”

“Send in the clowns!”

“Don’t bother, they’re here.”

Things are tense nowadays. Everyone has an opinion. And generally it is not a good one. It is full of sound and fury, signifying…frustration. The process is unfolding, it is unlabeled and the contents unknown. Like the tense surface of a water droplet skating across the leaf surface ready to splash at the first prick, this tension mounts as it wobbles, ready to burst open.

I happen to be seated at a café with some acquaintances when one fairly intelligent sort who had uncoupled the chemical bonds in the field of chemistry and used his capacious knowledge to advance the pursuits of a company blurted out, “You doctors have a monopoly in medicine.”

“Say what?”

“Yeah, anyone should be allowed to dispense and care for himself or another as a patient.”

“Say again!”

“Anyone can treat a disease or a malady instead of going to the “doctors!” and he emphasized the word with a certain touch of dark humor. He continued, “Every day you hear about some doctor caught prescribing unnecessary medications, some embezzling money, some causing grievous harm to others, some diagnosing disease where none exists!” He whistled, “I mean I can go on and on about what you doctors are up to. So with that why can’t the ordinary citizen decide what medicine he or she can take and get it from the pharmacy, especially now that we have internet and the same information at the fingertips?” He looked around for a moment then said, “I mean, if the doctor has to look up information on his smartphone or his tablet or the computer screen, every time, I ask him a question without saying two words to me why then, why should I visit him. But Noo,” he dragged at the no to its fullest elastic length that would come out of his pursed lips, “the doctor is busy dotting the “I”s and crossing the “t”s on his computer to get reimbursed while his nurse is telling him to hurry up for the next victim! No time for me! Well, I have news,  I have no time for him”

Interesting monologue, I thought. That came from left field like a sudden slap-burn on the cheek and right after a chicken sandwich laden with mayo. This form of monologue has been circulating in various forms in the social media recently too, drawing a multitude of warriors. These forms tout how doctors are really buffoons and haven’t been taught social media in the medical schools and how some don’t take social media seriously and how they are dinosaurs and Luddites. It is a common theme played out on the cyber-theater near you every moment of every second. And everyone falls in step with fingernails that can draw blood from underneath the white coat.

I thought for a moment and just then an intra-psychic thunderbolt hit my synaptic bundle…

Maybe the road that we as a nation have chosen; to vilify the doctors, by dumping billing data without context, and started on the path to demonize those that have billed more than the norm, patronize them, tell them they don’t have manners, or empathy, that they do unnecessary appendectomies, or that they cause harm by doing too many CT scans, which cause cancer and those who lack the requisite knowledge to differentiate between the need and the want, or lack the know-how of caring, that a computer is better than their intellect and intuit and that the nurses and assistants can deliver similar if not better care, well then what does one expect? It is game over.  The walk-off home run hitter is trotting from third to home base. And through it all, they, the doctors, are made to comply with absolute idiocy of electronic medical records to boost information gathering that harms patients through one size fits all and helps insurers to harm the doctors in return financially. These are people working hard try to comply with various and sundry mandates that are only dreamt of in a bureaucratic philosophy, which take away from the time that should be spent with the patient. The more the number of mandates, the larger the unbridgeable gulf between the patient and the physician grows. And then the blame game ensues, to the tune of billions of dollars being steadily siphoned away by the mandate makers and lobbyists, against the doctors and firmly centered in the crosshairs is guess who? ..the white-coat wearing, stethoscope bearing physician. Who suffers? The Patient mostly, for now. When we have holographic doctors driven by a air-condition-cooled remote IBM Watson sorting out between "cluster-headache" and "migraine," then we shall see.

“Maybe you are right!” I replied to the smart and intelligent hydrogen-carbon-chemistry man.

Huh! You could see him taken aback and speechless. What followed is a tale for another time…

Maybe we have accumulated the requisite number of clowns already. We have done it to ourselves, allowed the insurers to dictate reimbursements, allowed the government to dictate the appropriateness of care based on costs, given the keys to medicine's cabinet to anyone willing to throw a rotten egg, and allowed the middling managers, economists, statisticians, mathematicians, bureaucrats, politicians, even Ravi the taxi driver in New York and Jason the hedge fund manager, the right to decide how medicine should be “practiced.” Meanwhile the elite experts pontificate about how everyone should be treated as patients, or how we have the right to free physical examination (BTW that doesn't work as a form of prevention and now given those costs they are shying away from that too), or how we should not be treated after the age of 75 or that cancer is a good way to die without treatment. I mean, what the heck is going on here?

Geez o’Peez where are we going?

Maybe we are already there.

“Where are the clowns?”

“Quick!”

“Send in the clowns!”

“Don’t bother, they’re here.” 

http://youtu.be/8L6KGuTr9TI