Saturday, September 08, 2012


When, a good trillion years ago, I ill-conceived the notion of becoming a doctor, I had an image in mind, an image constructed out of assorted bits gleaned from books and movies: a white-coated scientist, alone in a lab at night, peering down the barrel of a microscope. Always alone, always at night, always gazing at the microscopic world of tissues and microbes and sometimes even doing so in a primitive grass hut in Africa -- an image so vivid that it has surely been lifted intact from some long-forgotten movie.

The closest I got to this doctorly ideal was pathology class in the second year med school, and internship, on call, doing gram stains of pus in the deserted basement micro lab.

The very first hospital patient ever assigned to me (third year med school, Worcester, Mass, 1976) was an occasion of abject terror. I tiptoed into the room and meekly introduced myself. The patient promptly and angrily informed me that he was passing a kidney stone and I should leave immediately.

I should have gotten the message. Could it have been any clearer, any more providential, more oracular ? I should have tossed my little black bag out of the window of the now defunct Worcester City Hospital, and headed west, down Route Nine, into the sunset.

Mais non. Heaven forbid I should have listened to my heart.

Now, decades later, I am reflecting on how absolutely, unremittingly excruciating everything since then has been. A whole new set of images arises, culled from Catholic hagiography -- swarms of flaming arrows, drawings and quarterings, crucifixions, burnings-at-the-stake. Oh, sure, I'm being histrionic. But turn it around: picture a gregarious extrovert, a hale and hearty "people person," sentenced to 30 years in a solitary cell with nothing to do but peer down the barrel of a microscope.

He rests my case.

And, insult to injury, I have been at this game long enough to witness the invasion of the management consultants. Is there a more chilling sound than the clatter of the stilletoed women in power suits -- consultants -- striding down the clinic hallway ? Or a more dislocatingly absurd sight than one of their company seated all all day in the same corridor plying a stop watch (reading, between times, Fifty Shades Of Gray.)

You can't make this stuff up.

I am in a new world now. A world where there are no disasters, only "challenges." A world of market share, decanting, cannibalization and backfill. The world of the Studer Group. Of Leadership Academies. Of the "Achieving Excellence Journey," and its companion trip, the Journey To Magnet Excellence™,Of Kaizen Muda and Gemba. Of LEAN. Of "hardwiring AIDET." Of acronyms such as TEAM (Together Everyone Achieves More) -- to which I have added my impotent, whispered cavil, SOLO (Some Obvious Loners Object.) And of that most seductive siren of universal allure and acclaim, Virginia Mason, who will, by all accounts, make everything right.

Yeah, yeah, sure, healthcare is a mess, something needs to be done, but heave forbid it should include embracing the proven efficiencies of single payer and abolishing the absolute chaos of the competing, contradictory, expensive, administrative demands of hundreds of insurance companies, where profit rules and care takes a back seat. Why shouldn't enterprising consultants flock to feed off this rotting carcass ? It's the capitalist way !

Where is the white-coated night doc and her microscope in all this, besides cringing in her office ?

Because of issues of market share, decanting, cannibalization and backfill, and due to her reluctance to be "leased" to a competing department, she is being deracinated from her 18 year perch in the Clinic of Little Miseries where she had hoped to finish out her waning doctor days, and is being sent across the river (AKA Route 93) to Siberia.

Causing her to reach back into the place from which she has recently apostasized (which is not untainted by The Managerial Invasion ) and pray --

For I am a stranger with thee, and a sojourner.
Spare me a little, before I go hence and be no more seen.

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