OBAD (The Dark Side of Doctoring) -Rule Number Four
OBAD stands for Official Begging Armistice Day. I’m sure that will require some explanation.
If ‘The Mandolin Case’ sells more than four books, I have a sequel planned. It is called ‘Acquisition Syndrome; the Doctoring Business.’ As far as what it’s about, legal advises me all I can tell you at this time is this: A wise patient of mine, a farmer, told my nurse Lynn O’Carroll, “Dr. B knows something and he ain’t talking.” But the gist of the saga is that along the way Dr. B learned a few tricks of the trade and figured out ways to get people taken care of even if some fool does their best to stonewall the process. It happens more often than you might think. To their dismay, over time I am gonna tell what I know.
Fifteen years ago if I wanted to get a CT head scan Lynn O’Carroll would call and say, “Dr B. needs a CT today.”
And they’d say, “Sure sweetie, what time?”
It is no longer that way. Now mind you I’ve never been one to order a CT on every headache patient. A history will usually do it. But if there is even one ‘red flag’ warning sign I’m on the warpath and will not be denied.
When you have a lady who has fallen in the last month and has a new headache like she’s never had, and you run into some insurance guru who finds a scan unnecessary, I always ask what he would want done if it was his mama. If he doesn’t want to rule out a subdural hematoma then there are only a few logical conclusions. Either he is poorly trained, doesn’t care, is more interested in money than truth, or hates his mama. None of them are good.
The idea of ‘managed care’ is if you make the Doc jump through enough hoops he’ll stop hopping and take a few chances. Sorry, I made an A+ in Hoop Jumping 101. Nowadays a Doc not only has to care, read like a wild man to ace his Boards (O.K. I’m gonna brag on my 94th percentile) and work hard, but he also has have an iron will to force the system to do right when it has created more inertia than a barge that lost it’s tugboat.
I call it OBAD. Official Begging Armistice Day. I never beg anyone for help. If they aren’t willing, I proceed to plan B, go to door number two and lumber on in anyway. It is the power of the lessons of Acquisition Syndrome; the 80/20 rule. (Rule number four) 80% of the time people will do right because they want to. The other 20% have to be positioned where they have no choice but to do right.
I can’t tell you the details of this week’s case. It is too fresh. Even if I fictionalized it, it would be recognizable and a breach of patient privacy. So instead I have to make it into a parable. But as I told Julius; “if they won’t do right make ‘em.”
On our flight this week, I was the pilot and Julius was my co-pilot. On Tuesday we hit some awful turbulence.
“Hey pal, my rudder is balky and she don’t wanna trim out. We’re losing oil pressure on the right engine. We’re gonna have to feather the starboard side and put her down in a cow pasture. I know one we can get to from here.”
“If anyone knows Harvey County, it’s you, Doc.”
“Go back there and get approval. Tell that arm chair QB it’s an emergency.”
Julius was back in a minute. “He’s say his computer simulation says it’s doesn’t meet the criteria. Procedure denied.”
“Tell him to look out the window. The dadburn engine is on fire.”
“I did. He said they have to go by protocol.”
I tossed Julius a chute. “Take this to him. Tell him he can jump if he wants to, but I gotta get this dude on the ground.”
“O.K., boss.” Julius turned to head for the back of the plane.
“Hey, kid. Tell him one more thing.”
“What’s that Doc?”
“He might as well take his computer too. It’s no good to us here. He might want to play some video games at least if he survives the fall.”
“By the way, tell him I’ll go ahead and call in my dictation. If this thing doesn’t make it I’m gonna document the fact he got in the way here. Legal will tell him not to worry too much. It’s only one passenger. She’s just some country lady and I know he doesn’t think she’s that important. I know the husband. He thinks right much of her, but he’s reasonable. My guess is five mill will cut the gig.”
Julius smiled. “I expect that man in a suit and tie in a Harvey County courtroom would have a hard go.”
“Yeah, remind him a dead Dr. B is gonna be a difficult opponent. You don’t diss dead people. Tell him it’s against the law.”
Julius did just that. The man froze. He was scared to go against us. When it’s your own life on the line, people see it in a different light, and besides the guy was tighter than Jack Benny.
We got her down, got the lady off the plane, and put out the fire. I told the little regulator man I believe I’d get some new software for his simulator. One of these days he was gonna convince someone more naive than me to go along with him when he’d never laid eyes on the patient. When he does he’ll have to hope I remain as obscure a writer as I am now. By the way, he admitted he’d never flown a plane. I wasn’t surprised.
The patient did fine, and I wasn’t scared until it was over. Then I cried. Medicine made me tough as a pine knot, but it ain’t gonna make me mean. I’m gonna go play some music.
I’m glad I did not spend my life as some insurance chart jockey. As hard as it was, I’d rather be Doc, even if the pay wasn’t as good as those executive guys. l’ll close with a favorite quote. It is from Sir William Osler, the father of modern medicine.
“Seeing patients without reading books is like going to sea without a compass, but reading books without seeing patients is like not going to sea at all.”
I love books, but I love patients more. Some things and people are forever. Osler was, but I assure you all those little regulatory guys will be lost to history. (as they should be) They are nothing but a nuisance to be thwarted, but I have learned to do it well. I’ll probably be lost to history too, but at least I tried to do right.
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