Scene: Family dinner table, a middle-aged couple and their son, home from college.
Father: “So, boy, have you figured out what you want to do with your life?”
Son: “Yes dad, I’ve talked to my counselor and I want to become a doctor.”
At that moment Mother swells visibly with pride and says, “I knew it. Oh, son you’ll make such a wonderful doctor. Maybe you can open up your own practice.”
Son demurs politely, “No mom. Once I finish my training, I plan on becoming part of an accountable care organization. You understand, financial and clinical risk means it’s essential to have the infrastructure to coordinate interactive team-based care. It’s all about being market competitive and empowering synergistic group and management service organizations that feature mutual arrangements on optimal practice management, health information technology, group purchasing, billing/collections, human resources, and other mission-critical functions.
Mother stares at him blankly.
“Son, Dr. Kildare and Marcus Welby never talked that way.”
Son stares at her blankly, unfamiliar with the reference.
Father chimes in with a more contemporary reference, “Don’t you want to be like that TV doctor, Dr. House, and make all those great diagnoses?”
“House? Are you kidding? He was a terrible physician. His style was completely dysfunctional within the parameters of a hospital environment and he had no concept of teamwork or care coordination. Plus his show got cancelled.”
Father stares at him blankly.
Mother, holding out hope, comes back, “Maybe you could be a surgeon like Ben Casey?”
Son with another blank stare at Mother. “Who’s Ben Casey?”
“He was the best surgeon on television. All night he’d be up operating and then they would bring in some poor little boy and Ben Casey would single-handedly save him with an emergency appendectomy.”
“Mom, it doesn’t work like that anymore. People don’t stay up all night and then operate. They have work limits now. I heard some surgeons talking on NPR and it’s a revolutionary paradigm trying to make surgical hours “family friendly.” And this business about this cowboy Casey singlehandedly saving the little boy? Don’t you understand there are dozens of people interfacing in that boy’s surgery? Surgeons aren’t heroes anymore. Anyway, they are programming robots to do surgery.”
A little disappointed, Mother says, “Well, I remember when that nice Dr. Green took out my gall bladder. I liked him. ”
A subtle eye-roll from Son.
Father chimes in again, “When you become a doctor, you are going to take care of patients, aren’t you?”
“Dad, it’s not really taking care of patients, it’s interfacing with clients. Medicine is about developing mutually beneficial models that focus on shared decision-making. The idea your doctor is the expert who knows what’s best is the problem with medicine. The future is in creating guidelines and algorithms based on an evidence-based approach. The goal of medicine should be to standardize, so clients can be managed through clinical pathways facilitated by lower cost providers”.
Son grows animated, excitement in his eyes, “Don’t you see, Dad? .You wouldn’t even need a doctor for most cases. My future could be in developing new algorithms for cases that don’t conform to traditional guidelines! And I could devise new checklists. Checklists are a revolutionary approach to medicine.”
Father, slightly taken aback, doesn’t know what to say so he says the first thing to come to mind, “Does that mean you won’t carry a stethoscope?”
Another eye-roll from Son, this time not so subtle.
Mother asks “I just want to know if you will still be helping people and making them better.”
Son, “Sure, mom. What you are talking about is outcomes. Don’t forget I will be interfacing with the electronic health record and it provides an industrialization function that enables process efficiency. Not only that, but the retrieval of clinical decisions, as well as cost and quality assessment, allows for iterative improvement. Do you have any idea what that means for outcomes?”
Mother says nothing but nods with a wan smile.
Son put down his napkin and says, “Mom, Dad. I’d really love to stay and chat some more, but I have to run. I’m going to a lecture on how medicine needs to become more like The Cheesecake Factory - you know customized approach, more standardization, and enhanced quality control. That is so 21st Century! ”
Son leaves. Mother and Father clear the table. A few moments of awkward silence until Mother asks, “Oh dear, aren’t you proud of our boy?”
“I guess. But there seems to be a lot of mumbo-jumbo in medicine today. I sort of wish he’d go into something with a little less doubletalk attached to it.”
“I don’t know. Maybe politics.”
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