Random Thoughts from a Restless Mind

Joe Mauer stayed home. Not only did he re-sign with the Minnesota Twins, he LITERALLY stayed home. Born and raised in St. Pau,l Minnesota Mauer can’t even get himself to go across the bridge into Minneapolis. Arguably the best catcher in major league baseball, with “told” riches laid out before him for the taking, he turned it all down in order to walk the same streets, shop the same shops, and see the same sights he has seen his entire life. Yup, old Joe doesn’t even have to find himself a new barber–the same guy  who cut his hair in high school still has the job!

Now, I live in Cleveland, and you might have heard about our own native son, kid named Lebron, who has a very similar opportunity before him. (I wrote a little about this in “It’s Not About the Money. No, Really!”). Lebron James appears to be the biggest, most important free agent in the history of the NBA. 25 years old and no worse than entering his peak years, Lebron is an unrestricted free agent.  Indeed, unlike Mauer, Lebron is actually unencumbered by any of the economic realities of his game or his league–his off the court income dwarfs what he has or might make in salary. As such he has the liberty to make his decision based on the non-contractual issues like the aforementioned off court income, or the adventure of exploring a new city, or mining the value of staying home.

It’s really hard to determine which of these two young men is more important to the economic success of this team, and the related economic success of his city. Knowing that Mauer would re-sign allowed Minneapolis to give the go-ahead to a new baseball stadium. Knowing they had Mauer in the fold, ownership has begun to sign other pieces to a championship puzzle. On the other hand the most conservative estimate of Lebron’s economic impact is that he has single-handedly increased the value of the Cleveland Cavaliers franchise by $100 million. This is probably ridiculously low; Dan Gilbert the mortgage king will have surely made the largest “underwater” major purchase in the history of sports should Lebron James leave now.

Lebron just completed his seventh year as a Cleveland Cavalier and despite yeoman efforts by general manager Danny Ferry and owner Dan Gilbert, Lebron and company have not been able to bring a championship to Cleveland. This has been his mantra, oft stated, that winning is his only priority. Only slightly behind that, though, is the goal of winning “at-home.” Lebron actually has more in common with Joe Mauer then it seems at first blush, for Lebron is not really a Cleveland kid at all, but kid from Akron. Indeed, Lebron built his castle in Richfield, equidistant as the crow flies from both Akron and Cleveland, but spiritually more a suburb of the former.

So what is Lebron to do? What does Lebron want to do? What SHOULD Lebron do? Our local paper, the Cleveland Plain Dealer, has been awash in stories, commentary, conjecture, and innuendo. A friendly acquaintance who writes for the Plain Dealer has been tasked with the onerous job of recording and reporting “Lebron rumors”, with absolutely no requirement to confirm anything she writes. It’s the Lebron-A-thon, all Lebron all the time! The hometown is actually getting smaller and smaller every single day.

What do I think? I think Lebron is a really smart kid, much, much smarter than the majority of sports fans give him credit for. He’s actually quite different from the majority of the kids who went straight to the NBA from high school, and pretty much all of the “one and done” kids who spent a year in college before beginning their careers. My bet is that Lebron would have been much more than the keeper of a “gentleman’s C” average in college. No, Lebron would have been a solid B student taking a real college curriculum.

He’s also aware that he will eventually screw up somewhere, somehow, sometime. He’s a pretty shrewd character to be sure, but he is also a 25-year-old who has openly admitted that he is still in the process of growing up. Cleveland is a pretty small place, more small-town than major city actually, and it’s pretty hard to hide 6′8″, 265 pounds of handsome wealthy young man. I’d love to be wrong on this, really I would, but my guess is that he senses the inherent safety of a truly big city.

Knowing this I still think Lebron is too smart to not see that he has placed himself in a no-win situation should he decide to leave Cleveland now. There’s been too much talk over the last several years about winning at home, and too little talk too late about what home actually is. I think Lebron realizes this, and I think he is using his unique position to maximize his chances of winning one for the “hometown.” I’m predicting some fancy footwork, behind-the-scenes maneuvering, and a couple of major surprise announcements at the end of this week, all of which give Lebron a chance to make good.

Then what’s the true value of staying home? Here’s my bid. The value of staying home is exactly one championship. My prediction is that Lebron signs a two-year contract with a player option for a third. If he wins a championship in either year one or year two he’s outta here. He made good, kept his promise, it’s time to move on. If he fails to win a championship in year one or year two he invokes his player’s option to great fanfare, with all kinds of emphasis on the sacrifices that he is making to stay in Cleveland. If the Cavs shouuld win championships in BOTH years one and two he certainly stays for year three, unable to resist being linked with Phil Jackson as the only architects of “three-peats” in the history of the NBA.

After that, come hell or high water, it’s Cleveland in the rearview mirror. Three years, over and out. At age 28 Lebron will be off to other pastures, new challenges, fresh horizons. World as oyster, and all that sorta thing.

Why? At the end of the day it pretty much comes down to the difference between Joe Mauer and Lebron James much more than it comes down their similarities or to the differences in their hometowns. Mauer has never sought the limelight. Indeed, he has actively sought the cocoon of small-town, hometown. James, on the other hand, has ALWAYS sought more. Even in high school he had one eye on the game at hand and one eye on the tomorrow to come. Nothing wrong with that, really. They are what they are, and it is what it is.

S0 what’s the value of staying home? One championship and three years to get it. You heard it here first.

 This whole Tiger bashing thing has never seemed quite on the mark for me, but until recently I really haven’t been able to put my finger on just why. Leave it to two of my touchstones, Crossfit and Sports Illustrated, to bring it into focus.

Selena Roberts opined this week that in some way Tiger is not worthy to take the crown from the great Jack Nicklaus, that his personal failures, his lack of “goodness” somehow disqualifies his results on his particular field of play. She goes even further, conflating l’affaire Tigre with the whole Barry Bonds/Mark McGuire debacle in MLB. Somehow Ms. Roberts is channeling Tiger’s aggrieved mistresses on our collective behalf, coming to the inevitable conclusion of the offensitive that Tiger’s behavior off the course nullifies his accomplishments on it.

Rubbish.

Unlike Mssrs. Bonds and McGuire there is no credible evidence that Tiger has altered the balance of the playing field through anything other than talent and effort. Not unlike our growing Crossfit competitions, it is nothing but the result that matters on the competitive pitch. Tiger has 14 majors, 70-something wins. Count ‘em.

Ms. Roberts commits the amateur’s error of amnesia, a particularly disappointing error given her experience and position as a national sportswriter. You see, most of the extraordinary athletic feats we extoll were performed by jerks, at least at the time of their performance. Raving egomaniacs, barely tolerated by their competitors, if tolerated at all. Think about it. Think about the signature athletic accomplishments in your lifetime and the lifetime just prior. Does anyone qualify as a genuinely nice guy? Happily married, kind to children and small animals alike? I’m sure there are others, but I come up with a very short list of Lou Gherig  and…Lou Gherig.

Jack Nicklaus? Ridiculed behind his back as “Fat Jack” by the jealous, and “Carnac” for his self-righteous know-it-allness. Possessed of an outsized ego and not really at all concerned with how he was perceived by anyone in his heyday, it was only at the end of his PGA career that the “Golden Bear” became teddy. Jack possessed that certain arrogance and dismissiveness of any and all not strictly necessary to achieve his lofty goals, similar in scope and kind to the various corporate chieftains of his generation (Se Welch, Jack, et al).

Babe Ruth? Come on. A veritable bull in the china shop of life, he mauled his way through the 30’s indulging appetites as outsized as Tiger’s. Openly jealous of the afore mentioned Lou Gherig, our collective memory of The Babe is air-brushed in the azure of ages past, just like Ms. Robers. Mickey Mantle? Spend a little time reading about his treatment of Roger Maris, or re-read Bouton’s “Ball Four”. The guy was a ton of fun, but virtuous is nowhere to be found in any true-to-life memoirs of The Mick.

Philanders, drunks and gluttons, or arrogant chieftains lording their superiority over their minions, the owners of most of our cherished athletic records are nearly uniformly men besotted with themselves, consumed in and by their pursuits, convinced only that they deserve whatever it is that they desire. At the very least they are possessed of overriding ego and an ability to channel their every effort in the pursuit of records, leaving in their wake a sea of collateral human damage.

Well, that…that…that just seems so WRONG. They don’t deserve our support, our worship. They should PAY for their misdeeds. Ah…here Ms. Roberts gets it just a little more right. They do, indeed, pay for being miscreants off the field, at least nowadays they do. Kobe loses millions in endorsements for taking liberties with one who was unwilling. Barry Bonds makes nary a cent off the field, and hasn’t since long before his hat size grew.  Mark McGuire is driven underground for YEARS after his retirement, cut off from both the succor of adoration that might come to the clean holder of a cherished record, and just as completely shut out of the riches that such adulation would bring. Babe Ruth, Mickey Mantle, Joe Louis and others in that era largely escaped this fate because of a fawning media who protected them. Ms. Roberts is quite right to decline that role, and quite right to unravel the tightly woven tale of Tiger that allowed him to accrue his nearly obscene off-the-course riches.

But “goodness” as a pre-req for greatness as regards epic athletic feats and achievement? Nonsense. It’s still exactly 100M, and it will remain so whether or not Usain Bolt becomes a bonehead. A home run is still over the wall, whether it’s hit by The Mick or Junior. We shouldn’t care where Joe Willie spent the night before as long as he beats the Colts the day after. We are indifferent that Lance Armstrong leaves everyone he touches with his bike in a flaming heap by the roadside, we simply yearn for Tour de Lance v 8.0.

Tiger will pay a price, has paid a price, for his behavior. He is down…what?…somewhere between $25 and $100 Million A YEAR in lost endorsemant money right now. You know, $25 Million here, $25 Million there, pretty soon you’re talking about real money, eh?

Me? I hope Tiger laps the field at both the British Open and the PGA. He plays golf by the same rules as Jack, Arnie, and Old Tom Morris; no gimmes, they still putt ‘em all out. Like Crossfit, every second counts, eh? Records are made to be broken and I want to experience the thrill of witnessing athletic feats of grandeur. I’ll decide whether or not to like Tiger based on his People Magazine profile, sure, and I’ll think about whether or not I buy something on his say-so a little more closely now, but I wanna see greatness on the golf course.

That’ll be good enough.

From Sunday musings on Crossfit.com:

Sunday musings…

Really just one thing on my mind today, Father’s Day. It’s a funny little day, really, in just the opposite way that Mother’s Day is a funny little day. On Mother’s Day we are prompted to remember to thank Mom for all of the thankless stuff she does for us, putting our needs first, before hers, on a daily basis. Mother’s day is our one day to expunge any guilt we might have for not noticing all that stuff as well as a day to tell her how much we love her.

On Father’s day we remember Dad’s in the house.

That is, of course, if Dad is actually IN the house on Father’s Day. Have you taken a moment to think about our time honored Father’s Day activities? You know…Dad goes off with his buddies to play golf, or he’s on a boat or in a stream somewhere fishing. It’s kind of a throwback I think to the days when Dads were the sole breadwinner in a one-income family and worked 6 days a week so that they could do a week’s worth of fix-it duty on Sunday. Father’s Day was that one “get-out-of-work” pass.

I always thought this was kinda weird, actually. I mean, Dad was gone all week at work, and he was sorta at work even when he was home during the week, engaging only when forced to by our transgressions or if we as kids asked him to help with some very major issue. It wasn’t malicious or unkind, just…distant.

If you’re a wonky egghead like yours truly you read stuff about the effect that Fathers have on their kids and the kids’ development. Turns out that just having a Dad in the house (as long as he’s not hurting folks), even one who mostly occupies a rocking chair with life swirling around him rather than through him, is actually really beneficial for healthy growth for both boys AND girls. Makes it all the more strange that we traditionally give the old guy the “day off” on Father’s Day.

I think I’ve always felt this way, even way back when I was too young to either know it or articulate it. When my Dad would play golf on Father’s Day I would make sure that I was a caddy assigned to his group. After my brother and I did the lawn I would plop myself down next to that rocking chair for whatever ball game or golf tournament was on the tube, ready to catch any stray words that might fall my way. Those could be some quiet afternoons, for sure, but those were also the rare days that ended in a hug.

Mrs. Bingo asked me what I wanted to do today for MY Father’s Day. She knew the answer, of course, because I’ve given the same one for 21 years now. I said I wanted to be included in all of the kids’ stuff, whatever they might have going on. I wanted to be THERE, even if there is not typically some place I might choose to be (garden, barn, etc). I thought I’d do some of the Dad stuff that they know me for, too, if they’d have me. I’ll be off to make buttermilk pancakes in just a minute.

So Happy Father’s Day to all of you Crossfit Dad’s. Remember to give your own Old Man a call; most likely he really DID love you and really DID like being your Dad, he just didn’t know how to say it. Then, if you can, jump right into whatever the kids have going today. Fully engage in the act of “Dadship”. Your kids will think that it’s you who is giving them the gift, but really it’s still your day and it’s still all about you today.

Giving yourself a day to be nothing but Dad. 3-2-1…GO!

The genius gene. I didn’t get one. To be fair, I was born in the deep end of the gene pool for all kinds of really cool stuff. I did get a very healthy dose of the “smart” gene; my mother is still convinced that I’m brilliant. But a genius? Capable of creating something totally new? Something that is earth–shaking, a game-changer? Nope. Don’t have it. I didn’t get that gene.

I got the “Salieri” gene.

You remember Salieri, don’t you? Salieri was the miserable soul who was not only capable of recognizing the genius of Mozart, but he was instantly aware that he would never possess that particular kind of genius. What  made him miserable, of course, was the fact that he was insanely jealous and bitter that his particular gift was the ability to identify someone else’s genius. This is one thing, though, that Salieri and I do NOT have in common. Rather than being bitter and jealous when I identify someone else’s genius, I am instead delighted, simply ecstatic to have made the discovery. Even more so, I am happy to trumpet my discovery, to tell everyone I know about a new genius or a new genius idea. And then I STEAL it!

Any genius ideas that I have ever been given credit for have essentially been derivative. I do have the gift of taking someone’s really good idea, maybe even a genius idea, and making it a little bit better. I have learned to take someone’s genius in one area and apply it somewhere entirely different, in a slightly different way, making something that appears to be totally new in that new place. Now, I always give credit for the original idea. It just wouldn’t be right to either take the credit for the “aha moment” or to fail to give attribution for the origin of my derivative. That would be a little bit TOO much like Salieri, wouldn’t it? It’s just really interesting how powerful the work of a true genius really is, for a true genius creation is applicable in areas that can range far and wide of its original intent.  It’s fascinating how few people do this, take a really good, original idea out of its universe and apply it somewhere else.

Take for instance Skyvision Centers.  From the outside sSkyvision looks like any other high–end specialty medical practice. But if you look just a little bit deeper you notice that Skyvision is actually a consumer service business; our product just happens to be eyecare. When I talk to other physicians about how we run Skyvision I get all kinds of feedback that includes the word “genius.” Looking not too terribly far below the surface, though, and you see lots of really good ideas from other parts of the business world that are simply being applied in a different setting. Our patient–flow principles are lifted directly from Toyota whose manufacturing principles, moving something through space and applying different processes to that something along the way, are widely viewed as a true genius breakthrough in manufacturing.

Skyvision is the first truly patient–centered eyecare practice in America. We built the entire business around one single patient, and every single member of the Skyvision team is borderline obsessed with maximizing the pleasure of a patient’s experience in our office. The office itself is designed to evoke other settings where patients have had a good consumer service experience. Our lobby looks much more like the front of a high end spa. High ceilings and wide hallways give the constant impression of space… elbow room… uncrowded. Even our carpet pattern was chosen to maximize comfort and minimize stress; it turns out that certain patterns make older patients unsteady on their feet and we gave our designers the task of avoiding anything that would cause subtle discomfort.

Not a single one of these ideas is new. I do not own the creation of any single element at Skyvision. What we have simply done is acknowledge good ideas elsewhere and put them together in a slightly different way in a slightly different place. Kind of like what would’ve happened if Salieri had been free of jealousy, free to simply revel in Mozart’s genius.  That’s me, a kinder, gentler, huggable Salieri, content to discover other people’s genius and then maybe  apply that genius in a little different way in a little different place. It doesn’t always work of course. Imagine if Salieri tried to adapt Mozart to the harmonica!  I’ve certainly done the equivalent of that, too.

Have you ever met a genius? A true genius? I think I’ve met a couple over the years. There’s a guy in New York, a neurologist, who may be the smartest person with whom I’ve ever actually spoken. He had about a dozen patents by the time I finished my residency. Of course, there’s also my brother-in-law Pete, the electrophysiology idiot savant. Pete’s actually probably a real, live, across the board genius, but he IS my brother-in-law and, come on now, there’s only so much credit you can give a guy like that who’s in the family! Pete can see stuff in an electrical tracing and relate it all the way down to the electrons changing spin, and then figure out how to fix what he sees with some new, off the wall solution. While he’s doing this, of course, what he’s really interested in is how he’s going to ambush me just before bedtime with something like “so, what do you think about God?” Genius.

There’s a genius in every walk of life. It doesn’t have to be something phantasmagorical like the gates to calcium channels along the heart’s electrical highway. No, it can be something as mundane as trash disposal. Baking bread. Or fitness. My most recent brush with genius has been in the world of physical fitness. That’s right… fitness. The most recent genius I’ve met is a fitness trainer from Southern California who came up with something no one else had ever been able to figure out. Something that no one has been able to dispute, argue, or contest. Greg Glassman defined physical fitness.

Herein lies another one of the characteristics of genius. You’re thinking to yourself, physical fitness, everyone knows what physical fitness is. Sure you do. Give me a definition. Define fitness…I’ll wait…ahem… still waiting… thought so. That genius thing always seems to make us go “of course!  why didn’t I think of that?” So it is with Greg Glassman and fitness. Work capacity across broad time and modal domains. Work, something you can measure. How much did you move how far how fast. Simple. Everything is now measurable. Every program designed to increase fitness can now be observed, measured, and compared.

Like most geniuses Coach Glassman didn’t stop there, though. The next little bit of genius was figuring out HOW to improve fitness in the most efficient and effective way. By utilizing “intensity”, by maximizing power  output while exercising Coach Glassman  as postulated a more direct, efficient, and effective route to producing physical fitness. Unlike most geniuses he didn’t require the help of any “derivative genius” like me to apply his two great discoveries. The creation of Crossfit, the broadly applied commercial version of his two genius breakthroughs, has done quite nicely without any help from me, thank you very much!

Nope, the place where I might be of some little help is in applying Greg Glassman’s fitness genius in the area of health. Not too very different from what I’ve done with the best practices that I found in manufacturing and consumer service in building sky vision. Coach Glassman has recently offered that fitness is a proxy for health; he has actually stated that measuring fitness is tantamount to measuring health. I think there’s a little more to it, just like I think there was a little bit more to applying best practice consumer service principles to medicine than just putting Nordstrom’s shoe salespeople in a doctor’s office. Sometimes the genius idea is just the starting line when it’s applied in a new way in a new place. Not too surprisingly, Coach Glassman and I don’t agree entirely on this at the moment, but that’s okay! Like Salieri I can find genius and geniuses frustrating at times. Unlike Salieri, though, I’m a patient man, comfortable with my role  when in the company of geniuses.

After all, they’re the ones with the genius gene.

…well, you know.

It finally happened; I have finally made decisions that were based primarily on covering my own  ass.  One of these decisions was strategic, and the other one was directly related to the care of one particular patient. Let me explain.

The first decision, the strategic decision, had to do with performing consultations in the hospital setting. These have never been a whole lot of fun, and they have never been a terribly profitable venture from a business standpoint. But for many years I, and most other off ophthalmologists in my community, have performed hospital consultations at the request of both community primary care physicians and hospitalists, pretty much whenever we were asked. Almost none of these consultations was mandatory, an examination that absolutely had to occur during the time of hospitalization. Oddly enough, or perhaps not so oddly, a significant percentage of the patients for whom these consultations were performed were uninsured, way more than the likelihood of this occurring due to chance.

That was okay, though, for the longest of times. Everybody was doing it, performing these consultations, and those of us who did so received a kind of “good Samaritan” benefit of the doubt. You see, we do such extraordinarily good work as a specialty, and that work is so terribly dependent on very advanced technology including large, expensive, and mobile equipment, that every consultation that we performed in the hospital setting was a pale, inferior product in comparison to a consultation performed in our offices. As time has gone on my sense that I would continue to receive this “good Samaritan” dispensation has disappeared. I have  come to feel more and more vulnerable, more and more concerned that the inherent deficiencies of the hospital consultation in  ophthalmology make it more likely that I will miss something important despite my best efforts.

And so I am now declining to  accept hospital consultations except when I am obligated to do so as part of my turn covering the emergency room.

Now, you could accuse me of being selfish, of using everything above as a simple rationalization to stop doing something that is inconvenient and unprofitable. It’s ALWAYS been inconvenient and unprofitable! What has changed is that it now feels more dangerous to ME.

I’ve struggled with this decision, frankly. In the end, though, the decision to stop doing consultations in the hospital was actually rather easy because the quality of care that I was able to provide in that setting was so dramatically inferior to the quality of care that I have been able to provide in my offices. It was a different event, a different decision made in the context of caring for one, individual patient that has brought home just how pervasive this climate of fear in which all physicians live has become. Faced with the decision that hinged on my safety versus the convenience and care experience of one of my patients, THIS time I chose my own safety, and I made the decision in a nanosecond.

My patient was scheduled for cataract surgery on her left eye. During her prep in the pre-op holding area it became clear right away that she had prepared at home for surgery on her right eye, putting her preoperative eyedrops in the wrong eye despite our verbal and written instructions to the contrary. What  should we do, the nurses asked? Easy answer: cancel the case. But her son had to take off work, and another family member took off work to stay home with her this afternoon. Easy answer: cancel the case.

It wasn’t always this way. Years ago, in the early 90s, a patient prepped the wrong eye for glaucoma surgery. Knowing that I was planning on doing both eyes eventually I simply changed course, changed all the paperwork, and went ahead and did the eye that she had prepped. Things are different now, though. There is a paper thin line between “other eye” surgery and “wrong eye surgery”. Wrong eye surgery is a “never event”, one of those things that is simply inexcusable, and one of those things that various and sundry watchdogs are looking to find. Take a chance on some overzealous, faceless, nameless functionary, perhaps someone who has never been involved in the surgical process confusing “other eye” surgery with “wrong eye. surgery? Not a chance…cancel the case.

And that was that. For the first time in my career I had put my own ass ahead of the convenience and experience of my patient. I willingly and knowingly inconvenienced by patient and her family, even though the eventual plan was to remove both of her cataracts, because I was afraid to change the surgical plan at the last minute. Afraid that some red flag would be raised because I had changed the surgical site. Afraid to expose myself to those overzealous, nameless, faceless functionaries.

I covered my own ass!

Again, one could accuse me of being self-serving, self-righteous even. This was the first time that I had ever knowingly made this kind of decision, and frankly I can’t even remember a time when I made a similar decision for a similar reason. What was so extraordinary was how instantly I came to this conclusion, how quickly the words “cancel the case” came out of my mouth, and how completely comfortable I am with the decision. Me, the champion of patient-centered medicine, borderline obsessed with the crusade to bring the best customer – centered practices from the best consumer service industries to medical care. I instantly and knowingly put my own self protection ahead of the convenience and experience of my patient and her family.

To be honest, both the patient and her son were very understanding, and she has gone on to have very successful cataract surgery on the correct eye. No harm no foul, as the basketball great Bill Russell would put it. But that’s not really true, is it? An entire system is set up in such a way that my decision has become the  ONLY viable decision. Only the foolhardy, the reckless, or the naïve would do anything else. It’s a non-choice anymore. We physicians, descendents of those who willingly and knowingly walked among lepers and ENTERED plague-infested cities, fearless in our professional service, we have finally met our match. Terrified by those nameless, faceless, functionaries, cowed by those most definitely named, whose pictures grace the covers of our phone books, we are now left with but one  course of action.

Physician, cover thine own ass.

Bob Ryan, the great Boston Globe sportswriter, is famous for a writing style in which he simply jots down short little “thoughlets”. He basically just throws out whatever’s on his mind, expanding on some thoughts, and just letting others dangle, tiny little flags sent up the flagpole. If you’ve ever read him, and if you pay attention, you notice that he occasionally revisits these “thoughtlets” with a much deeper examination.  This technique or style has been ripped off by countless other sportswriters, usually without attribution.

Over the course of my day-to-day life I find myself interested in countless little ideas, tiny thoughts, or random observations. Not all of them are worthy of the full attention of the “Restless Mind”, but I think a lot of them really  ARE interesting, and I really hate to lose  them. So I thought on occasion I, too, would steal this technique from Mr. Ryan, only I am going to openly acknowledge that it’s his, and openly thank him for giving me the idea. So, without further ado, here are some  random thoughts banging around between my ears…

1.)  Lacrosse.  I am absolutely up to my eyeballs in lacrosse this weekend, and loving every minute of it. My son Randy had a  game yesterday, and looking back I realized that I spent at least six hours in front of ESPNU watching NCAA lacrosse as well. It’s really a fantastic sport. I’m a little guy, and lacrosse would’ve been a great sport for me when I was younger. Unfortunately, I didn’t come upon lacroses until I was a high school junior, and I didn’t get a chance to actually play lacrosse until I was in college. I was a pretty typical football player turned lacrosse player — great wheels, no stick. I was a defensive midfielder before the position actually  existed. “Hey, Darrell, see that kid over there? Yeah, that one. The one who knows how to play lacrosse. Go beat the crap out of him and don’t let him score!” Yup, I was THAT guy.

When my oldest son, Danny, started playing in junior high school I rekindled my love for the game. I’ve been telling people for years that lacrosse is the perfect game for boys. You get to do everything your mother ever told you NOT to do: you get to run with a stick, and you get to HIT people with! Seriously, how good is THAT?! It’s funny, though, because it’s exactly this part of the sport that is putting this wonderful, lovely game at risk in our local public high school.

You see, our athletic director is concerned that lacrosse is inherently a dangerous sport. He’s concerned that the injury rate is, or will be, much higher than all other sports simply because it’s lacrosse. I don’t think that’s the case. As a matter of fact, after watching very high level lacrosse on television this weekend, I’m convinced it’s not the case. I say this after having watched my youngest son, Randy, get the snot beaten out of him in his last three games (Randy is an attackman who plays the “X.” position; he has the ball an awful lot making him an inviting target).

What the athletic director is actually seeing it is a rather unskilled version of the game. As such it’s really not any different from unskilled versions of any other contact sport. Who among us hasn’t seen an unskilled basketball team rough up the team made of five extremely skilled but rather slight hoopsters? Or the soccer team that consists of brutes, muscling their opponents off the ball? Or the classic example, the hockey team whose tactics consist largely of muggings on skates? No, it’s not the game. Lacrosse is no more or nor no less injury-prone than any other contact sport.

It’s really quite beautiful, and I have to make sure our athletic director realizes this.

2.)  Women’s lacrosse. If you love men’s lacrosse you’ve probably watched a game or two of women’s lacrosse. While I write this I’m watching the Virginia women beat Towson State in a playoff game. They have lacrosse sticks, they shoot at 6′ x 6′ goals, and the ball spends an awful lot of time in the air being passed from player to player. The similarities seem to end there, though. It’s a totally different game!

I’m I’m reminded of watching my sister play field hockey in high school. Man, talk about a game with lots and lots of rules, totally impenetrable to all but the chosen few who have been initiated in some secret athletic rite. I could never figure out why any whistle was blown in field hockey, and I have to confess that I’m just as bewildered watching women’s lacrosse. The women are very fast, clearly elite athletes, and they’re certainly holding lacrosse sticks and shooting at lacrosse goals.

I hope I figure out women’s lacrosse in less time than it took me to figure out field hockey!

3.) There was a  very insightful article, an interview of the great economist Gary Becker in the Wall Street Journal couple of weeks ago. Becker touched on all kinds of topics, and spent a little bit of time on one that’s very close to my world, namely healthcare economics. He’s a little frustrated, heck were ALL a little frustrated by the willful obfuscation foisted upon the great unwashed mass of humanity that doesn’t work inside the Washington DC beltway when it comes to health care economics.

A case in point is the effect of out-of-pocket expenses on the overall amount of money that is spent on healthcare in any given country. In the United States we presently spend about 17% of our GDP on healthcare. Out-of-pocket expenses make up only about 12% of total health-care spending. In Switzerland, however, a country widely acclaimed for a very effective health care system, and equally acclaimed for spending only 11% of GDP on healthcare, the Swiss have out-of-pocket expenses equal to about 31% of total spending.

Swiss consumers of medical care are assumed to  have the ability to make complex medical decisions on their own behalf. Do you think maybe, just MAYBE there is a correlation here? Do you think that perhaps the fact that Swiss patients individually own 31% of the skin in the game has anything to do with driving overall healthcare costs lower? That perhaps the fact that every healthcare transaction is roughly 1/3 the responsibility of a patient, thereby involving every single patient in the financial aspects of every single health care decision, might be in part responsible for a lower percentage of the GDP being spent on healthcare?

Nah. Couldn’t be that.

4.)  Aches and pains. My partner Greg Kaye turned 41 years old this week. Greg actually handled the “turning 41″ part much better than I did 50, only finding it difficult over the last month or so. Greg is also a former athlete, just a little less  “former” then yours truly. But Greg has struggled over the last month or so because of a couple of nagging injuries which have limited his athletic exploits, and consequently reminded him that he is no longer 21.

I’ve got pretty much the same chronic infirmities that I’ve had for several years. I’ve made my peace with them, at least I think I have. The difference for me now is that every time something new crops up I’m having a hard time putting aside the thought that it’s not just a little niggling effect of being 50 years old, but that it might actually be something serious. I’m starting to see friends, and friends of friends die. Some of them are dying from common things, and some of them are dying from relatively uncommon, weird things. I have a little bruise on my trachea right now. In all likelihood that’s all it is. The good news: I probably won’t put a tie on for a week or so. The bad news: until I put a tie back on I’m going to be wondering.

We used to call this “medical students disease”, the phenomenon where every medical student came down with whatever disease we happen to be studying at the time. I apparently was never cured of “medical students disease”!

I got a bill the other day for care that was provided to a member of my family. The care was provided at one of the huge behemoths here in Cleveland. Now, this was just an office visit, not anything exotic like a fancy test or some new surgical procedure. And yet, there it was, at the bottom of the billing statement: “facility charge”. I knew it would be there, but still seeing it made me chuckle. “Facility charge.” What a great gig! Not only do you get to charge for the professional services provided, but you get to put a separate fee to cover your overhead on the bill! Dude, where can I sign up?

Well, that’s just the point. I CAN’T sign up for that cruise. You see, I’m a physician in private practice. You know, old-time medicine. The doctor owns his own business, pays the rent, makes payroll every two weeks. If something breaks he or she writes a check. Exactly like the pediatrician when you were a kid who gave you that scratch on your shoulder when it was time for your polio vaccination. No “facility charge” associated with that visit! Nope, Just a few dollars passing between your mom and the lady manning the front desk. You never really thought about what happened to those few dollars, of course. Heck, you were only seven! Your mom never really thought about it either.

Until recently the vast  majority of medical care provided in the United States, at least care that came from physicians, was provided at the hands of private practitioners like me and like that pediatrician you saw with your snotty nose as a kid. Contrary to the wishes of countless faceless bureaucrats in Washington, a significant percentage of care continues to be provided in exactly the same way. Even in very large, institutional medical groups a “facility charge” is nothing but a happy fantasy. The money that your insurance company pays to your doctor does NOT go into your doctor’s checking account until all of the bills are paid

This is why the proposed 21% cut in physician’s fees for the care of Medicare patients is so much bigger than even 21%. This is also why it’s so difficult for patients who are covered by Medicaid to find a doctor. The notion that somehow increasing the Medicaid rolls, taking people off of the uninsured list and placing them on the bigger list of people whose medical care might be covered by Medicaid, is such a farce. People who have Medicaid now have enormous difficulties getting access to the care that they need. What makes those same faceless bureaucrats think that they have made any headway increasing access to medical care by putting more people on Medicaid? Doctors and most hospitals avoid seeing patients on Medicaid, just as they will avoid seeing patients on Medicare if that 21% cut goes through, because they DON’T GET PAID.

Well, how about technology? Is it possible to increase the efficiency of doctors working in their offices with the use of new technology? Efficiency, yes. Efficiency while making sure that our doctors get paid, no.A USA Today article looking at the daily workload of primary care doctors found an average of 55 services performed each day in a 4  doctor group that went unpaid. Services like answering phone calls and refilling prescriptions, reviewing lab reports or consultation reports, or interacting with patients by e-mail.  On the face of it,  increased access to your doctor through alternate venues, something different than coming in to the office where the bricks and mortar have to be paid for makes sense. It makes sense, that is, if the doctor gets paid for it!

Why should you care if your doctor gets paid? I mean, didn’t President Obama point out how much pediatricians get paid for taking out a  patient’s tonsils (read that carefully)? Wasn’t it some huge number that made no sense? Aren’t we supposed to be moving toward a system where doctors are paid a salary, where there’s no incentive to order extra tests or do extra procedures since we know that doctors are incapable of separating their own economic interest from the best interests of the patients in 2010? You know, like World Class Hospital, repeatedly beatified by both the President and those same nameless, faceless bureaucrats in Washington, held aloft as the shining beacon of hope, the one true path to higher quality care at lower cost.

Funny, that. The World Class Hospital is actually an extremely good example of both the best and the worst of where healthcare economics has been and where it might yet go. The World Class Hospital is enormously successful financially because it has mastered the arcane business of doing as much as possible for each patient within the rules of the billing game. There would also be that “facility charge” thing where the bricks and mortar are covered by a surcharge. Although the doctors at the World Class Hospital do indeed work for a “salary”, in many cases that salary is tied directly to not only their own personal production, but also to the amount of money that is generated at the institution as a secondary effect of their labors. Human nature being what it is this produces two very different types of behavior on the part of doctors at the World Class Hospital, and indeed doctors everywhere who are paid like this. While there is still upside, room to do more work and thereby prove that a doctor should be paid more, the doctors are always available. Ready to work. Access to these doctors is rarely a problem.

Unfortunately, the opposite also occurs. Once a certain salary level has been reached many doctors simply slow down. It’s a funny quirk in the system, salaries are rarely if ever decreased. Why work harder if there is neither incentive to do so, nor disincentive not to? The best example I’ve seen recently is a group of general surgeons formerly in private practice who sold their group to the World Class Hospital. This group used to be noted in the community, especially among primary care doctors, for the amazing availability of the surgeons. Whenever a patient needed surgery, or whenever a patient needed a surgical consult, one of these doctors was ALWAYS available. Now? Not so much. 9-to-5, Monday through Friday. Why? Well, they don’t get paid for all of that availability anymore.

It’s a funny thing, money as an incentive. It’s an even funnier thing, how forgetful everyone becomes about money as an incentive when it comes to paying doctors. The mantra from Washington regarding “health care reform” has been the fantasy of better care and greater access at a lower cost. Doctors  to work harder, work longer, and be available to all of us whenever we need them.  We want this as we walk around with “alligator arms”, unable and unwilling to reach for our checkbooks, appalled by a $15.00 co-pay, insulted that there might be some service or care that’s NOT COVERED BY INSURANCE. More and more for less and less… who wouldn’t want that?  I do wonder, though, what the reaction would be if all doctors handed their patient an itemized “bill”   detailing what happens to that egregious $15 co-pay. At last count in our office? Exactly $3.00 to me.

You know, come to think of it, I got paid pretty well in the year 2000. I think I’d be okay with my 2000 salary; you can even keep the 1% pay raise. I’d be willing to work for my year 2000 salary, maybe with a little cost-of-living raise, you know, like the one those nameless, faceless Washington bureaucrats get every year. I’d even be willing to work the way I’ve always worked, available pretty much 24 – 7, 365. How would I do that, you wonder?

Well, let’s talk about that “facility charge”…

Who do you see when you look in the mirror? When it’s just you and the mirror, and no one else, whose gaze do you meet coming from the mirror? Each one of us travels the highway of life cloaked in various masks and disguises, ever more complex shields between  what others see of us, and what we see when we stand alone, bared, in front of the mirror. Do you ever do this? Stand in front of the mirror stripped bare of all artifice, neither masked nor cloaked? What do you see? Who looks back?

It’s funny; whenever it’s me doing the looking the guy who looks back always has a soul patch!

So much of our lives are spent creating the image seen by others. What does Mommy want me to do? What would Daddy think of this? It starts very early, you know. We don’t even know we’re doing it. We get better and better at it once we leave the house, perhaps to a friend’s house to play, but certainly when we first enter school. We learned that a certain pose, a certain way of speaking, indeed the very way we stand elicits a response from the person standing opposite us. In a way, that person is another kind of mirror, except that this mirror shows us the effect of our “makeup”, our masks, our armor.

Who among us hasn’t experienced the intense, deep, boring pain that comes from sharing some deep confidence with a friend only to have that friend break our trust and share whatever that confidence was with someone else. We see a part of our true selves reflected in that circulating confidence; it’s always a painful experience, isn’t it? The lesson here is that baring the reflection of our true self can be painful. And so, we don’t.

Moving on we project for a purpose. Meeting our college roommate for the first time, that first job interview, lunch with the boss’s boss. What’s in the “mirror” is really more of a projection of someone sitting next to you or standing in front of you, and less a projection of you, who you really are. There’s nothing wrong or bad here — we simply do what we need to do. But in doing so we often drive that pure reflection of who we really are deeper and deeper, further and further from whom we appear to be.

Many of us sneak a little bit of self into the public projection, almost like an inside joke which is hidden from almost everyone. Maybe it’s a tiny tattoo on the inside of your ankle or that third hole in your year which you only fill for “outside consumption” in the most comforting and welcome circumstances. Nobody can see your tattoo, and nobody knows what type of the earring fills that hole, but YOU do. For me it’s a soul patch.

Now my wife, the single most important person in my life bar none, HATES my soul patch. Hates every version that I might dream up. Hates it long and dark; hates it short, neat, and trimmed. I had a mustache and a goatee around the time of my 40th birthday (no issues turning 40, mind you) and frankly I thought I looked pretty darn cool! It worked for little while, until that is it started to get gray. My lovely daughter, Megan, asked me to shave it as a Sweet 16th birthday gift to her and POOF, away it went. But every now and then the soul patch reappeared, tolerated for progressively shorter periods of time and always wiped clean at the behest of my beautiful bride. Except when I looked in the mirror, when it was just me and who I really think “me” is. I always see the soul patch.

If you do spend some time in front of a mirror and if you do open your eyes enough to take in that true image of who you really are the next thing you realize is how very rare are the occasions when the person who shows up is that reflection in the mirror. They are almost “never” events. When they happen, and when you all of a sudden realize that THIS event is one of those times, it can be almost magical. Think about it. You’re in a place and you’re with people and it’s so comfortable that the person YOU see in the mirror, the person you think you really are, is the exact person who shows up. And that version of you stays! You’re in a place it with people who know you, the exact version of you that looks back from the mere when you allow yourself to see who you really are.

It almost never happens, and the few times that it does create memories that are like monuments. Your own “Mount Rushmore” event. You return to those memories, you return to those events as  if they were touchstones, little shortcuts to who you really are. I had one in my 40s that is so meaningful that I can remember all of the details as if I just came home. My friends Bruce and Kathy invited Beth and me and three other couples to be their guests for an “adults only” ski trip. We spent five days in Telluride; Beth was injured and she didn’t even ski. Every minute that I was there I was exactly the man who stares back at me from the mirror. It doesn’t always turn out this way, but for me it was an extremely positive experience. I really liked the guy walking around in my clothes, and everyone else seemed pretty good with him, too. For five days the guy who looks back at me from the mirror when I’m looking at the guy I really think I am and I were one and the same.

It hasn’t really happened like that since then. Oh sure, there are little snippets here and there. A date with Beth, an hour in the office, a morning session at a Crossfit certification was my son Randy. But nothing like five days. Yet, when I’m there in front of the mirror, just me and the Darrell I think I am, it’s still the guy who spent five days in Telluride with friends new and old, all of whom saw the same person I see in the mirror.

So who are YOU when you look in the mirror and the person you really think you are is standing right there in front of you? Do you do this? Shorn of all disguises, all masks, all forms of armor and defense, who looks back at you when you are looking… for you? What do you look like? Who do you see?

I always see a soul patch…

I was in Providence again last weekend. I really need to stop visiting because every time I go it reminds me of how little has been done to save Cleveland since I wrote my article last year ( “Saving Cleveland” ). I mean, for crying out loud, just look at the headlines in the Cleveland Plain Dealer on Sunday: “Medical Mart budget hidden from County cCommissioners”. Seriously? A $500 million project and the guys running the show can’t see the bill? Really?

I guess it’s time I admit it. I missed the boat. I assumed that we had folks in Cleveland running the show who might have something in common with the people who ran Providence during its resurrection. BZZZZZT. Sorry! Johnny, tell Dr. White about our lovely parting gifts.  We unfortunately have elected politicians and other leaders with mis-matched talents. They are either men and women   with enormous hearts and limited abilities (think city government), or politicians blessed  with enormous talents and limitless intellect who are saddled with hearts the size of a pre-Cindy Lou Who Grinch. For crying out loud our politicians can’t even get corruption right! The guys in Providence were “effectively corrupt,” lining their pockets while getting the job done. Ours? Well, you read the same newspapers I do.

Nope, I was wrong. Saving Cleveland is not going to come from our entrenched leaders, be they politicians, businesspeople, or community  organizers. Saving Cleveland is not going to be a “top-down” process; saving Cleveland is going to come from the bottom up. Judging by the stunning lack of success our “leaders” have had with their “swing for the fences” strategies, I was at least a little bit right in “Saving Cleveland”– Little Ball is still the game that needs to be played to save our city. One year on, though, and the strategy becomes a little more clear. We need lots of little people playing little ball. Thousands of bunt singles will still score runs. What we need is a bit of an insurrection.

Alright Smart Guy. Lots of fancy words in there. Just what you mean by “bunt singles”  and how exactly do you propose we do this? I think it’s a back-to-the-future kind of thing. When I was looking for a place to live all of my college classmates who had grown up in Cleveland were dying to get back to the City. Mind you, this was when the Cuyahoga River was on fire. And yet all of my friends were “pants on fire”  hauling back to Cleveland. I think that’s the key; I think that’s the group, those are the same people who need to embrace the Save Cleveland movement. We need another generation of young people, high school and college aged kids who decide to “love” Cleveland and bring everyone else along with them.

The saying is way easier than doing, of course. It always is, eh? In this case the say is easier still because we don’t even have to create the blueprint — it’s already been done several times in several places. We, someone, preferably the kids need to do three simple things: PROTECT Cleveland (demand that our officials make our cities safe), BUY Cleveland (always choose products made by, or services provided by local companies), and CELEBRATE Cleveland (that “love bomb” thing I talked about before).

A couple things have become clear to me over the course of the last year. I already mentioned my profound disappointment in our “leaders”, but I’ve been equally disappointed in other civic and business organizations. Our main newspaper, the Cleveland Plain Dealer, continues to take potshots at Cleveland. No fruit hangs too high if the picking will produce a story knocking the city. For the most part our television stations and radio stations are equally guilty of this type of behavior. This is not the information infrastructure that will be necessary or useful in saving Cleveland.

What we need is a new way now, the stuff that our young people use as a matter of course in their daily lives. I’m talking, of course, about social media. Facebook, twitter, Linked In, even that old standby MySpace… the way our young people talk to one another. New music is shared on Facebook. An ad, a video, or a movie goes viral on YouTube or Hulu. The “game” of saving Cleveland, all the little examples of Little Ball will take place in the stores and shops in the streets of Cleveland and the surrounding suburbs, but the talking about it will take place in the “blogosphere.”

PROTECT Cleveland. Our young need to take back the streets. They need to take back the malls and the stores and the schools. They need to be encouraged and supported when they “call out” bad stuff. They need to be encouraged and supported when they demand that our elected officials make every nook and cranny of Cleveland safe. This is the table-stake; we simply can’t throw them under the bus on this one. We can’t lose the next Flats.

BUY Cleveland. This one should be easy, right? I mean, we’ve got pretty much everything we need here in Cleveland. That’s what makes it so utterly amazing and infuriating when we learn about how difficult it is for great businesses in Cleveland to get Cleveland business. Did you know that the city of Cleveland’s website was designed by and is hosted by a company in Denver? Seriously. Denver! How wrong is that? It’ll apparently have to start from the bottom here, too. Every kid, every young executive, every young professional will need to seek out others just like them who live and work in Cleveland and do business with THEM.

CELEBRATE Cleveland. If our established institutions insist on accentuating the negative we’re just going to have to find another way to drop that big old “love bomb” on Cleveland. How about a campaign where the kids tell the story of every Cleveland experience they have, every Cleveland business they use, every Cleveland  place they visit where something about it was good? Do it on Twitter. Do it on Facebook. Post video on YouTube. Tell your buddies, and tell them to tell theirs. A fight for Cleveland, a fight for the hearts and minds of Clevelanders, each one of them a reporter with a sideline pass!

There you have it. Saving Cleveland, from the bottom up. Thousands of Cleveland people, Cleveland’s young people, coming to bat and bunting for singles. Little ball. Opening Day is today. Why not?

Batter up!

Skyvision Centers has a subsidiary company called the Skyvision Business Lab. We do business process research for pharmaceutical companies, medical device companies, and other medical businesses in the eye care arena. One of the companies we have worked for is a very cool company that produces animated educational videos for a ophthalmologists and optometrists. I had an interesting experience while talking to their chief technology officer. It was interesting because the conversation proved our basic reason for existence at the Business Lab, that it is impossible for any company to develop, sell, and install any kind of product in our world without understanding the ins and outs of every day activities in an eye care practice.

Of course, I always find it extremely interesting when I’m right!

It was a tiny little point, really, but how could you know something this small and seemingly insignificant unless you had spent time on the “frontline” of medical practice? The chief technology officer for the video company was frustrated because doctors and their staff were not using this really cool product that they had purchased. Furthermore, because they weren’t using it, they were failing to buy downstream products from the video company. As it turns out the salespeople for this company were telling the doctors that this particular product should be “turned on” by the staff at the front desk of the office. This is exactly the wrong place because the front staff personnel simply have neither the time, nor the understanding, nor any incentive whatsoever to do this! The product actually works beautifully if it is “turned on” by the back-office staff. Bingo! Problem solved.

So what does this have to do with Electronic Medical Records (EMR), and for heaven’s sake what does this have to do with underpants? It’s simple, really. When was the last time you bought a totally new type of underpants, underpants that you had never seen before, and underpants that you had certainly never worn before, without trying them on? Furthermore, what’s the likelihood that you would allow someone else to design, fit, and choose a style  of underpants for you if that someone has not only never met you but has never even seen a picture of you?!  That’s the image I get every time I read an article about EMR.

In theory the concept of an electronic medical record that would allow permanent storage of every bit of medical information, with the ability to share that information between and among doctors and hospitals involved in the patient’s care is so logical and obvious that debating the point seems silly. If you have ever seen my handwriting, for example, you’d realize that the entire field of EMR was worth developing just to make doctors stop using pens and pencils! Trust me on this… the doctor hasn’t yet been trained who is also a specialist in penmanship.

I actually trained at  two of the pioneering hospitals in the use of electronic medical records, and indeed in the use of computers in medicine in general. Dr. Larry Weed and Dr. Dennis Plante at the University of Vermont were pioneers in the concept of using computing power to make more accurate medical diagnoses. Both the University of Vermont Medical Center and the Maine Medical Center were among the very first institutions to develop and implement digital medical records for the storage and use of clinical data like lab reports and radiology reports. In theory both of these areas make sense, but in practice the storage and display of clinical data is all that’s actually helpful in day-to-day practice.

If this is the case, if the acquisition, storage, and retrieval of critical data is helpful, the next logical step must be to do the same thing with the information obtained in doctor’s offices, right? Well, in theory this makes a ton of sense. The problem is that nearly none of the EMR systems now in place have been designed from the doctor — patient experience outward; they’ve all been designed from the outside in, kind of like someone imagining what kind of underpants you might need or might like to wear, and making a guess about what size would fit you. With a few exceptions, tiny companies that are likely to be steamrolled in the process, every single EMR on the market is the wrong fit for a doctor and a patient.

Why is this? How could this possibly be with all the lip service that is being paid to the doctor — patient relationship and the importance of getting better care to patients? It goes back to that same tiny little problem that the medical video company tripped over: it’s really hard to know how something should work unless you spend some time where the work is going to be done. Electronic medical records in today’s market are responsive to INSTITUTIONS, insurance companies and governments and large hospital systems. System before doctor, doctor before staff, staff before patient. Today’s EMR’s have been designed with two goals in mind: saving money and reducing medical errors. Should be a slamdunk at that, right? But even here the systems bat only .500, producing reams of data that will eventually allow distant institutions to pare medical spending, but neither capturing nor analyzing the correct data to improve both medical outcomes and medical safety. Fail here, too, but that’s another story entirely.

So what’s the solution? Well for me the answer is really pretty easy and pretty obvious. Send the underwear designer into the dressing room! Program design, programs of any type, are one part “knowledge of need” and one part plumbing. How can you know what type of plumbing is necessary unless you go and look at the exact place where the plumbing is needed? How can you know what size and what shape and what style of underwear will fit unless you actually go and look at the person who will be wearing the underwear? It’s so simple and so obvious that it sometimes makes me want to scream. Put the program designers in the offices of doctors who are actually seeing patients. Set them side-by-each. Make them sit next to the patients and experience what it’s like to receive care.

THEN design the program.

I’m available.The  Skyvision Business Lab is available. I have a hunch that the solution will hinge on something as simple and fundamental as my example above — front desk versus back office.  It doesn’t necessarily have to be me, and doesn’t necessarily have to be us, but it absolutely is necessary for it to be doctors and practices like Skyvision Centers, places where doctors and nurses and staff members actually take care of patients. Places where patients go to stay healthy or return to health. Places where it’s patient before staff, staff before doctor, doctor before system.

For whatever it’s worth I’m 5′8″ tall, I weigh 150 pounds, and I’m relatively lean for an old guy. I guess it’s a little embarrassing to admit this… I still wear “TightyWhiteys”, but I’m open-minded. I’m willing to change.

Just take a look at me first before you choose my underpants for me.