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Are MDs More Effective At Running Hospitals Than MBAs?

It’s been more than five years since Henry Mintzberg released the enlightening book ‘Managers, not MBAs’, a well-reasoned criticism of prevailing management education that basically revolves around Master in Business Administration (MBA) programs. Financial crisis was not even in sight but Mintzberg, a professor at McGill University in Montreal and one of the most important guiding lights in the questionable field of management, already pointed out that it was a serious danger for modern organizations to rely on professionals that had just finished their MBAs as the prime source for senior managerial positions.

Mintzberg focused his criticism on two essential aspects. First, most programs are aimed at people with no previous experience or knowledge about organizations and how they look like from the inside… and these same people then storm into companies believing that the real world works exactly as business school taught them it does. The second point is that many of these business schools spread a perverted set of values, such as the hunt for short-term profit, the belief that a good aim justifies any means and the urge to translate all human behaviors into accountable figures (the ‘countophrenia’ depicted by Vincent de Gaulejac in his must-read ‘La Société Malade de la Gestion’).

Then the crisis rose, and many CEOs of the biggest organizations had their share of responsibility for it, as they were enjoying multi-million dollar bonuses while taking their companies to the edge of bankrupcy. Most of them came from the most famous business schools in the world. I have outlined in the past the outrageous conflict of interests of many of these institutions, starting with Harvard, as Charles Ferguson perfectly displayed in his brilliant documentary ‘Inside Job’.

‘Social Science and Medicine’ published in its August issue a very interesting work by Amanda Godall, professor at the IZA Institute for the Study of Labor in Bonn, Germany. Godall’s is the first empirical research on the correlation between hospital results and having MDs in their top managerial positions. Read more »

*This blog post was originally published at Diario Medico*

America Boycotts Personal Responsibility

How expected. The CEO of whole foods says that government is not the solution to out of control health care expenditures. He says we are. The American people are responsible for out of control health care expenditures. He preaches a life of personal responsibility, of personal choice and actions that lead to health. And what does he get for it?

A boycott. From the article is this commentary:

Pragmatists on all sides of the health care question (and probably every political question) believe that, on the whole, human nature does not change, and we’ve got to fight or not fight the health care war with the citizenry we’ve got, not the one we wish we had. Utopians like Mackey, on the other hand, believe that public-policy debates are only a middle step in the real solution to our problems, which is to change human nature. The solution to our health care woes, Mackey seems to believe, is for all of us to become like him—hyper-rational in evaluating our options, hyper-responsible in following through on them, and devoted to healthy living (that plant-based diet!).

Yes, that is actually the solution, to become more hyper-rational in evaluating our options, hyper-responsible in following through on them, and devoted to healthy living. The fact that this commentator makes a mockery of personal responsibility, instead choosing to support couch potato, Chetoo eating, Oprah watching smokers with for all their health care needs because, well, that’s just what humans do, is pathetic.
If you want someone else to pay for your health care, be prepared to play by their rules. And the rules have to change. Or there won’t be any money for anyone. Ninety-nine trillion dollars says so. Making humans entitled to the side effects of bad habits because that’s just what humans do is a race to the bottom mentality. It’s at the core of the finance quandary. Encourage bad habits by paying for them, and you get bad habits. Nobody can sustain that model of third party financing.
Would you insure a house who’s participants stated up front they would burn it down? Would you insure a car from a driver who said he would intentionally drive it into a brick wall? If not, why would you buy insurance for people who intentionally did things we know destroys them?
The CEO of Whole Foods should be hoisted onto the podium next to Obama for all the world to applaud. Obama should declare a God given right to live healthy (and he should quit smoking for good) and a God given right to pay more for your insurance if you don’t. It’s about personal responsibility. It’s not about handing you a plate of free insurance and saying go smoke ‘em if you got ‘em.

*This blog post was originally published at A Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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