October 3rd, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, News, Opinion
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Could understanding the tacit rules which govern play on a neighborhood playground help us explain why some aspects of implementing healthcare reform are unlikely to succeed? Recent news involving McDonald’s Corporation suggests so.
On the playground, there are some simple precepts — like the fact that older and stronger kids get to make up the game, and the rules. That’s understood and mostly okay. As if these leaders are considered modestly benevolent and the rules are workable, the game is good and all benefit. And all players on the playground know this basic tenet of fairness: That the rules of the game shouldn’t change in the midst of the competition, and, taking it one step further, if the rules have to be changed they weren’t very good in the first place. Soon, if those in power become too controlling, too conflicted, or too self-serving, kids stop showing up, and the games cease.
In enacting this, our government gave us a very complicated game, with oodles of rules. (For the record, the PPACA of 2010 is 475 pages and 393,000 words.) But then, on further consideration of the rules, important players (McDonald’s) decided that they could not play. They were pulling out of the game, and they had many friends (Home Depot, CVS, Staples, etc.) who may not have spoke outwardly, but surely felt the same way. Read more »
*This blog post was originally published at Dr John M*
September 26th, 2010 by John Mandrola, M.D. in Better Health Network, Health Tips, True Stories
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“It was the best of times, it was the worst of times…”
An intermission, the curtain has closed on youth, but the next act awaits.
Caring for hiccups of the heart, like atrial fibrillation for example, often throws me in front of the mirror, of middle age that is, and sadly the reflections show imperfections. Since I am middle aged myself, there are my own experiences. But everyday at work, on my job site, I see the effects of these same middle-age experiences on the atrium of my patients. The results are often profound. So must be the pressures.
I read a passage in the wee hours of the quiet morning, in the dark, with a flickering book light. It grabbed me. It is from Elisabeth Strout’s Pulitzer Prize-winning, Olive Kitteridge. Read more »
*This blog post was originally published at Dr John M*
September 10th, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, News, Opinion, True Stories
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“Ouch! That really hurts! You win, please stop torquing my arm behind my back. “Uncle! I said, Uncle!!”
Yes, the threshold has been reached. We docs no longer need a tennis court or a Mercedes, our kids are fine in public schools, and we will happily buy our own damn pens.
But, please, just give us some modicum of autonomy. Throw us a measly scrap and let us take care of our patients as we see best. Like Dr. Saul Greenfield so beautifully said today in the Wall Street Journal. The paragraph that stood out the most for me is as follows:
Physician autonomy is a major defense against those who comfortably sit in remote offices and make calculations based on concerns other than an individual patient’s welfare. Uniformity of practice is a nonsensical goal that fails to allow for differing expression of disease states.
Really, it isn’t hyperbole to surmise that the overwhelming majority of doctors would decide, if faced with a choice between less compensation and less autonomy, to choose less compensation.
As a teen my dad told me the best part of being a doctor would be the autonomy. He was right, and that’s what hurts the most these days.
JMM
*This blog post was originally published at Dr John M*
