Tuesday, September 11, 2012


The Surgeon recently read another New Yorker piece (Big Med)  from the renowned surgeon/writer Atul Gawande.  This particular piece makes the startling claim that medicine would be better off (more efficient, cheaper) if it started to emulate the kitschy, impersonal chain restaurant Cheesecake Factory.  Yes, the same mega-chain notorious for the massive portions and enough calories per meal to fuel a man for three days.  Again, Cheesecake Factory.  The premise being that American medicine could stand to take a few pointers from one of the leading contributors to the national obesity epidemic. 

Initially the Surgeon suspected the piece was meant as satire, some sort of ironic parody of Gladwellian cross-analogizing of disparate disciplines.  But Dr Gawande is a serious man.  He has always written with a naif-like earnestness that makes him especially compelling.  So the Surgeon read the damn thing again.  And again, it is clear that the way of the future (per Gawande) lies via the corporate business model of the Cheesecake Factory.  The Surgeon is stupified.

Apparently we would all be better off if large, for-profit conglomerates like Kaiser and the Cleveland Clinic ran things.  All the doctors would be employees and the major medical equipment suppliers and pharmaceutical industries would be beholden to the bargaining power of regional healthcare monopolies.  This is the Utopia that awaits us.   

Dr. Gawande envisions a future where Eagle-Eye Big Brothers in out-of-state cockpits actively second guess the decisions of local, on-site physicians via hidden cameras and patching into the EMR.  He positively drools over the idea of replicating the Cheesecake system of "rating" each dish as it comes off the prep line for surgery and medical care.  The Surgeon can just imagine, before visiting with family and loved ones,  checking in with his "unit supervisor" after a gallbladder removal to make sure his technique received at least a score of 8 or whatever the hell the metric ends up being.

The Cheesecake Factory.  Cost effective and delicious.  Doctors as line cooks. 

The sad part is that physicians are to blame for all this nonsense.  Too many years of selfish bickering and self-interested clinical decision making (unnecessary joint replacements, cardiac caths sans indications, incestuous/corrupt relationships with Big Pharm/medical suppliers), along with a more recent phenomenon of sagging work ethic (I don't wanna take call more than three times a month), and financial motives (I wannna be a dematologist because I owe 250 grand in loans) have led to this position where the leading insider physician health policy wonk can advocate for assembly line medicine with the concommitant deprofessionalization of doctors and be universally lauded rather than laughed out of the room. 


Anonymous said...

"Dr. Gawande envisions a future where Eagle-Eye Big Brothers in out-of-state cockpits actively second guess the decisions of local, on-site physicians via hidden cameras and patching into the EMR."

-Already happening in many ICUs as standard practice. Some nurses like it, some don't. Just push a button and get a intensivist who can see and hear and write orders on the fly, no waiting and large fries and a coke with that too - which is good because we are always hypo.

But you are also very right on the changes coming Buckeye. They've been working on a way to gain ultimate control over you guys for a while now. Got most of you to fall for the line about 10 years ago, now they can force anything. The delay is only because they were thinking they would need to do these things delicately. But now, I think they realize that is not necessary once you got just about everybody in that holding pen. It's not Obamacare, it's corporate strategery that's been planning this for decades.


Paracelsus said...

"The sad part is that physicians are to blame for all this nonsense."

Couldn't agree more.

The single most important resource in healthcare is the staff, and especially the highly skilled specialists. It's the only resource where quality cannot be guaranteed by basic control.

Therefore, medical staff has always been in a privileged position, which sadly remained unexploited. Instead of taking a stand and dictate (yes, dictate, no less!) the policy every step of the way, doctors chose to give-in to bribes (let's call them by their proper name) from the employers and the healthcare/pharma industry, and to insurance blackmail.

We are now seeing a consistent world-wide (I've worked in more countries than one, and I have doctor friends in many places on our Earth) phenomenon of dumbing-down of doctors, which is worrisome to say the least. The amazingly stupid and cowardly attitude of "covering oneself" for every possible litigious scenario has led to unimaginable abuse, such as in the case of antibiotics, which in turn generated huge problems and financial burdens (in the case of antibiotics we now have widespread resistance in the population, and we screen all admissions for MRSA, with gargantuan costs, when all of this could have easily been avoided). The medical industry bosses are rubbing their hands in delight -- sales are up.

Doctors are now the hostages of malpraxis insurers, of their employers, of the industry. Many of us simply gave up trying. Just follow the policy. Do the work. Collect your pay. Stay safe (i.e. out of court). Stay rich.

I don't know why we've given up. Probably has to do with human nature, after all. For if tomorrow, by way of some odd, Twilight Zone worthy turn of events, there were suddenly no doctors at all on the planet, all the drugs, and all the machines, the entire system, in fact, would amount to absolutely nothing useful. But a huge, meaningless and costly pile of high-tech bureaucracy. Such is the power doctors actually have, and are willingly, and absurdly, giving it away.

Frank Drackman said...

Wow, glad to see you're back!
You're the only Ohio State fan I know, and now that you've got a real (i.e. SEC) Coach, maybe you can get back to the BCS title game again, and lose to another SEC team...
and what's the deal with Cheesecake anyway?
I mean I like Cheese, and I like Cake, but together?? its like drinking milk with a Chili Dog...

Frank "SEC RULES!" Drackman