Archive | June 2011

If John McEnroe Had Been a Surgeon…

It has been just over 30 years since the famous John McEnroe tennis tirade enshrining the phrase “You cannot be serious!” took place.  The event was triggered by a service ace which was called out.  In general, it was a case of a specialist (the tennis player) unhappy with the performance of a utility figure (the judge).  How does this relate to medicine and surgery?

Surgeons sometimes have tantrums in the operating room.  This isn’t a surprise to anyone who has spent time in or around operating rooms, but it might be to a general reader.  The reasons for tantrums vary, as do their frequency.  A lot depends on the personality of the surgeon.  Some never have tantrums.  Others have them every day, sometimes every case.

There is a lot written these days about “disruptive physicians”, and this kind of behavior is probably improving.  What is clear is that under an employed model, surgeon tantrums will be less tolerated.   I speculate that two factors will be important in evaluating the response to a disruptive surgeon: 1) The surgeon’s financial contribution to the hospital, and 2) How rare is his specialty?  Low-volume surgeons in common fields should not try to imitate John McEnroe very often.

But why do surgeons have tantrums?  It is important to realize that the person with the most at stake during any operation is the patient.  Next in line is the surgeon.  If something goes wrong, it is the surgeon who faces the family, who manages the complication, who gets the malpractice suit, and who faces the medical board.  Sadly, not all surgeons are of high character, but most are.  And they take it personally when preventable problems threaten their patients.  There are plenty of things that take place in operating rooms that can frustrate surgeons; distracting staff shift changes, waits for equipment that should have been available, staff not familiar with certain equipment, and the list goes on.  I recently heard of a surgeon who was frustrated that the operating room did not have a specific item that had been requested over a week before in preparation for a certain case.  I can picture that scenario playing out as follows:

Surgeon:  “Okay we can open the [special item].”

Staff:  “We don’t have that at this facility.”

Surgeon:  “What do you mean you don’t have it?  You can’t be serious.  You CANNOT BE SERIOUS!  I specifically called for that over a week ago!  The patient is under anesthesia, we’re half way through this case and you’re calling around looking for what you should have had?”

Now, I don’t condone tantrums by surgeons or by anyone else for that matter.  They are not part of how rational adults should behave.  But I’m sure they occur in every sector of the economy from time to time.  And I understand why they sometimes happen in surgery.  Yes, the surgeon should have confirmed the item was there before beginning the case.  But for the surgeon to verify every conceivable detail prior to the case is not possible.  At some point the facility must be accountable.  One way to improve care is to realize that paying attention to what the surgeon requests is not about tolerating tantrums or coddling primadonnas; it’s about having good systems in place so there are no mistakes.  That is better for everyone, especially the patients.

And by the way, John McEnroe went on to win that 1981 Wimbledon match, tantrum and all.  He also won the tournament.

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Three Health News Headscratchers

Today there were three health related stories that raised eyebrows across America.  Rather than get into a detailed dissertation of each, I will list each of them with links, and a brief commentary.

First, an article proclaimed “Doctors reaffirm insurance responsibility stance”.  I think the first headline was something to the effect of “Doctors support health law” but if so, it was later altered.  The headline is deceptive, because it is the American Medical Association that proclaimed the above position, not a majority of American doctors.  It should be remembered that only about 17-25% of doctors are members of the AMA.

Next, we heard that a misguided soul attempted to rob a bank for $1 in order to receive health insurance.  James Verone apparently hopes to become an inmate; with all the rights, responsibilities, and health coverage afforded that distinction.  He claims to have back, foot and other ailments, and lost his medical coverage during the economic downturn.  His desperation seems sincere, but he may benefit more from a psychological evaluation.  Robbing a bank?    Was there any attempt to exhaust all other methods of getting care before trying this stunt?   It seems hard to believe that all the doctors in that fine country area of North Carolina were unwilling to help him.

Third, we learned that a “glitch” in the health reform law may make it possible for couples with incomes up to $64,000 to qualify for Medicaid.  Supposedly this is not a concern, since this loophole should be corrected before the law goes into effect.  But it underscores the fact that nobody read this groundbreaking law very closely before voting for it.  To be fair, most of those criticizing it didn’t read it very closely either.

Penny Payment Citation Symptom of Healthcare Billing Confusion

A man in Utah reportedly earned a disorderly conduct citation and $140 fine for dumping 2500 pennies on the counter as payment for a $25 clinic bill.

Anyone familiar with health care billing knows it is a convoluted, entangled mess, far removed from the relative sense of order present in most areas of commerce.

My guess upon hearing of this incident is that the gentleman was frustrated over this charge and undoubtedly has spent a lot of time over the phone dealing with (probably) unhelpful people in trying to resolve the matter.  Next time he might have better luck if he pays with pennies that are either wrapped or placed in some type of container.