WHERE THE SUN STILL SHINES

I found it interesting having just arrived at the meeting from outside, where the grass was velvet green, flowers peeking over each other to get the rays, while the bees buzzed around with their nectar and the trees fully clothed witnessing the chirping birds building nests for a comfortable summer. Indeed, it was Louis Armstrong’s “Wonderful world” day out there.

But in the cramped darkened quarters of this large auditorium where almost all seats were occupied, the speaker was animated and challenging with questions to keep his audience from dozing. He seemed to paint a picture of a bleak world, no, not the one I had exited to enter his. It was a bleak world, devoid of color. Metaphorically he had dressed down the trees to their bare branches and painted the grass a drab patchy-brown color. And flowers? Forget them. Not a one in his dystopian viewpoint. Clearly this was a significant (not in a statistical sense) departure from my perceived neural substrate. The space-tie continuum was disrupted. The space where I was, the time just passed and what it is this talking head expert was proposing for the future, were at odds. Minsky would call this the collapse of his “Temporal Segmentation Boundary.”  The expected norm was violated and in its stead was a rude exposition of a single mind’s dilapidated shack in the air.

And yet, here I am trying to reconcile the beauty outside with this throw the darkest color on the brightest of canvas and call it a masterpiece sort of view. What was this speaker’s angle, besides the doleful drab and murky future? Another mechanism directly gathered from the Heath brothers book “Made to Stick.” Call up an anecdote and generalize it to all then make the claim of your personal ideal or ideology and push it in through the exercise of marketing and promotion. Soon the legions of the pseudo-journalists pick it up and claim their favorite Newspaper front-page column and all is well in this corner of the cubicles, except what is really out there, the… truth!

Ah yes, he claimed that physicians were responsible for 95,000 to 135,000 unforced errors that led to premature deaths. Of course, he brought up the “Jumbo Jet” analogy of “1 jumbo jet crashing every week of the year,” correlating mightily between imagined stuff and estimated stuff, thus making all sorts of “stuff.” He cautioned however, those were very conservative estimates. Implying there were more in the morgue than met his eye. From there he polished off some more “talking points” of the experts. “Too many tests,” he said, “was causing too many unneeded procedures.” Okay, I thought, where was he going next?

I didn’t have to wait too long, “Imagine,” he said, “the healthcare costs of $3.4 Trillion,” and he laid emphasis on the “Trill” of the trillion with a shrill that had everyone on the edge of their seat as if watching “Exorcist” for the first time. His sermon continued for what seemed an eternity, filled with graphs and statistical jargon only an illiterate would love. Struggling to keep my attention, my mind was back to the living world outside.

There is mercy in time. The whole darkness lasted a full 90 minutes and then everyone was allowed to mill around, stretch their legs and grab a coffee to awaken their senses or what was left of their temporo-parietal-frontal cortex.

I find this disjointed, poorly thought trough ode to disaster being played out at most medical meetings and in all the opera houses of the medical Academies and Associations. All of these “experts” seem bent on pointing the fingers at every one of their former colleagues as the cause of the plague that has beset the medical industry. And there is no question about the fact, that Medicine is now an Industry. It employs more MBAs and administrators than it does doctors. Perhaps you know that in the waning months of the 2015-2016 the fastest growing segment in employment to keep up with the regulatory burdens of yesterdays, was the medical office complex. So, clamoring about the rising costs and blaming the physicians has now become a “art du jour” an art-form perfected to a point where non-physicians are considered better in rendering patient care than physicians. To that effect the non-physician industry is booming at a 30%-90% growth rate per year as the overall physician numbers decline steadily from attrition, depression, suicide and other assortment of non-fun reasons. This is helping the bottom-line of the Insurer industry whose Topline and bottom-line continues to grow YOY. Payout less for mediocre services and call it topline care. Yet as history has taught us in the last 2 years the diagnostic workup has escalated dramatically due to indecision and lack of understanding of medicine. Cheaper labor, cheaper product and marginal healthcare is what the Medical Industry is glowing in the dark about these days.

Treating patients is a complex chore of understanding the malady and rendering an opinion for alleviating the rub. It comes naturally to those who have happily gone into the profession for the sake of healing, spending countless months and years in the process. Yet, if one were to listen to that “esteemed speaker,” the sky was falling with deaths and destruction everywhere and all around due mostly at the hands of the physicians’ follies.

Why such a disconnect? It appears there is more to the story than meets the eye. Experts and the wealthy lobbyists who have “NSITG” (No Skin In The Game) have determined that their future is safe and that they can pay their way to a healthy future by the world leading authorities in subspecialty medical care should they need it, but the rest should be limited in the use the resources. For the plebian, the non-physicians would serve as the gateway to average health, just shy of full recovery. After all Malcolm Gladwell’s 10,000 hours are now trimmed to an average of perhaps 2,000 hours. And I for one still think that 10,000 was the bare minimum in just comprehending the nuance of Anatomy and Physiology.

But here is the interesting part in that 90-minute lecture that I failed to mention earlier, simply to keep you on the edge. At the end of the lecture, a wide eyed newly minted free thinker asked if the current state of medicine was more as a result of the administrative complex with its associated managerial brigades acting as middlemen and women collecting large sums as intermediaries, rather than the costs of the physician’s rendered care? The hush that followed was spell-binding. After a few ‘ums” and “ohs” the speaker countered with a question, “So your premise is contrary with the facts, I just mentioned?” Huh? What facts? He was merely pontificating without any facts in his more than 60 slide-deck of see this then do that. Slowly the rumble started and other hands shot up and an abrupt end came when the organizer had to usher everyone out to the beckoning fruit plates, croissants and coffee outside the auditorium. Another disastrous reality averted.

It appears, and you might have noticed it also, that when a question is asked against a set of conjured facts, the answerer can only be responded to with another question or with hyperbole of a prepared rhetoric. To confuse and obfuscate under the duress of falsified data is the name of the game. Get used to it, or fight it, I say. Kudos to the free thinkers amongst us.

Calls into question the malarkey that exists in medicine and the larger society as a whole.

Well back to the beauty outside where the sun still shines and the birds still sing and the children still at play. Enough with these Medusas and their serpentine “values” that turn one into a petrified urn of fear.