Image above is a 2000 year old child potty trainer from ancient Greece.
Accepting turds as a fact of life from an early age prepared me well for a career in medicine.
Growing up, my father and great uncle built a small outdoor aviary in our back yard, where we raised tropical finches and quail that we sold to pet stores as my father’s side hustle.
In grade school, I entered the aviary (the size of a modest bathroom) twice weekly as dad’s helper to feed and maintain the roughly two hundred birds that called it home.
I learned quickly that hats were a necessity, because turds dependably fell onto my head from the heavens.
When I became a physician, universal precautions could not protect me from the technological and bureaucratic feces that showered the practice of medicine. Electronic Health Records? Computerized Physician Order Entry? Press-Ganey? JCAHO? Sure, these turds went disguised by more elaborate names, but having endured such offenses since age eight, I brushed them away and labored on.
What I did not realize is that, rarely, the turds that are dropped onto our heads from the great bird of health care occasionally contain a golden egg. To understand this alchemy you need only approach it from the correct perspective.
A case in point is a friend we caught up with recently, a gastroenterologist in a town where the single university hospital is the local 800 pound gorilla that all physicians are forced to reckon with.
Let’s call my friend Dumplestiltskin.
Dumplestiltskin joined a private community practice out of fellowship, and a few years later he invested with his partners in new construction on an outpatient endoscopy center.
The goal was to avoid leaving money on the table by being able to charge for facility fees, and exchange outdated hospital facilities (which the university refused to replace) with state of the art suites.
Additional benefits for patients would be cost reduction for their patients, since hospital facility fees exceed outpatient facility fees. Benefits for his group included the ability to hire staff responsive to their needs.
The university hospital was not amused by the prospective loss of revenue and turf, and insisted that my friend’s group halt construction of the private endoscopy center or risk losing their hospital privileges.
Dumplestiltskin and his partners chose not to capitulate, and surrendered their hospital privileges.
Another turd soils the downtrodden GI doc, right? Not exactly.
My friend and his partners thought through the consequences of losing their hospital privileges. Their group is highly sought-after by patients for personable providers with impressive educational pedigrees who give excellent care.
Furthermore, Dumplestiltskin’s smaller and nimbler group offered a human touch that no large bureaucracy could match. Need a last minute appointment? How’s this Friday at 4pm? Need an urgent appointment via the university behemoth group? How’s four weeks from now?
Loss of hospital privileges would eliminate the need to provide consults on admitted patients. In addition to making weekdays end closer to schedule, it restored nights and weekends as seldom interrupted family time.
Call went from a dreaded reality to a minor inconvenience, since it was conducted entirely by telephone. Those patients sick enough to require admission were seen by the university gastroenterology service, hospital employees who now exclusively shouldered the burden of the ED call panel.
Had the practice been in sink or swim mode, losing hospital privileges might have dealt the group a fatal blow. Instead, it quickly made my friend’s job the best one in town.
His group became GI proceduralists who never entered the hospital, mostly slept through the night, and were in demand more than ever.
Before you resign yourself to the latest turd that falls from on high, take a moment to glove up and sift through the details. You might just find a golden egg buried within.
Or, as Arthur Miller so memorably put it in Death of a Salesman:
“The jungle’s dark, Willie, but full of diamonds.”
Might he unknowingly have been describing a GI practice? You decide.