I just finished watching the Challenger: Final Flight doc on Netflix…
There are two public tragedies that defined me as a young person: The Challenger shuttle explosion in 1986 and the murder of Selena Quintanilla Perez in 1995. These were my “JFK” moments. Today I focus on the Challenger. Some other time, I will write about Selena.
As I watched the Challenger documentary series, I felt chills as I drew haunting parallels between the disastrous conditions that led to the tragedy and the current status in the health care industry. By the 1980’s public interest in the space program had waned. The addition of civilian and teacher Christa McAuliffe to the crew for that mission not only rekindled media and public attention for that particular launch, it also created some pressure for NASA officials to launch on the selected date. While I am certainly no engineer, rocket scientist, or physicist, as a physician with expertise in quality and process improvement, I was most struck by the following points in the docuseries:
- The management and directors at NASA and the Thiokol, the engineering government contractor that provided space shuttle parts, did not listen to the engineers who had been sounding the alarm prior to launch about safety concerns of a little part of the solid rocket boosters, the O-ring.
- The general public watching the launch did not realize for several minutes that the shuttle had exploded and something had gone terribly wrong. “We did not know what we were supposed to see.”
- I take this quote directly, because when I heard it, I had to pause and rewind it multiple times. “Lawrence Mulloy [Marshall Space Flight Center Project Director] was operating under the constraints of a system that required more launches than they could successfully make.”
Four Thiokol engineers pleaded with NASA and Thiokol management to delay the launch to another date. Engineers are the most educated and knowledgeable members of the space program, specifically when it comes to the function and mechanics of the shuttles. They were alarmed that the freezing temperatures that day would cause a “catastrophic” malfunction in the O-rings of the solid rocket boosters. Bob Ebeling, one of the rocket engineers, even detailed a memo outlining the problems with the subject line “Help!” to the directors.
This seriously sent chills down my spine.
For years, physicians have been sounding the alarm about dangers in the healthcare system: overregulation by insurance companies/government/bureaucrats, alarmingly large patient panels, barriers to physician communication, tasks normally assigned to physicians being done by people with less training/knowledge/expertise. And no one is listening. Physicians, the most educated and experienced members of the ENTIRE health care industry, have lost control of decision making which has been co-opted by administrators, directors, managers, and other bureaucrats, many whom have no direct health care experience. These are people that are not in the trenches,
sitting in front of a teen contemplating suicide,
in front of a first-time mother crying because she feels overwhelmed,
in front of a family whose child has just received a devastating cancer diagnosis.
These bureaucrats are telling doctors to move along and see 20, 30, 40 patients per day, because that is how a doctor’s value is measured: how many billable encounters they generate each day. Holding a distressed young mother’s hand doesn’t pay the bills. Seeing 40 patients per day does. But it doesn’t matter if a doctor tells their “manager”, “director”, or “administrator” that they need more time with patients, because the doctor is no longer in charge. The doctor, much like the engineers of Thiokol, can send memos, hold meetings, or scream “HELP!”, but nothing will change in the current corporate medicine world. Shuttles need to launch. Doctors need to bill. And the most educated professionals in the field are no longer calling the shots.
I think explosions are already happening in the healthcare industry. Of course it is, as the time we have with patients shrinks more and more, patient panels grow exponentially to justify a physician’s “value”, and doctors face the choice of either doing hours and hours of uncompensated work on their own time, delegating tasks to people with lesser level of licensure, or accepting that they will deliver care that does not meet their standards. The difference is that these explosions are not broadcast by the media and in front of hundreds of spectators.
The similarity? Those who are watching, the patient and family, often don’t realize an explosion has happened. They don’t know what they are supposed to see.
Patients accept that its “normal” to wait one hour or longer to see a doctor in a germ-infested exam room.
They accept as “normal” to have multiple barriers between them and the doctor, and that they will not speak to a physician unless they schedule an appointment for something that can easily be handled by phone or text.
They accept as “normal” that they will not have all their questions answered at a single doctor’s visit, and that if they ask a question, the doctor’s answer may very well be, “I am sorry, we are out of time, please schedule a separate appointment so we can discuss that.”
In no other industry is this appalling level of service acceptable. I love my hairdresser at Legacy Salon, but you can bet I would stop going if I had to wait over an hour after my scheduled appointment time to see her. If my appointment is at 2 pm, then I expect to be seen at that time or within a few minutes after that. (To clarify, Angie at Legacy is always punctual. Love you Angie!). Yet this level of inefficiency is tolerated in the health care industry because patients think that is the way it’s supposed to be, instead of realizing that the wait times are a symptom of a broken, inefficient system that completely disrespects both the customer (patient) and the doctor.
Lawrence Mulloy had a Bachelor of Science in engineering, but both of his graduate degrees were in administration. It was clear that he was a bureaucrat first, engineer second. When the Thiokol engineers recommended the night before that NASA delay the launch, Mulloy’s response was “My God Thiokol! When do you expect me to launch? In April?” At that point, the launch had been delayed twice due to weather and technical issues. The whole country was watching. There was renewed interest in the space program because a civilian was part of the crew for the first time in history. Mulloy and NASA did not want to lose that momentum. There had been talk about maybe a kid or Big Bird going up in space. Girl Scouts and other children’s groups had already made their way to Cape Canaveral to watch the launch. Mulloy certainly felt the pressure to avoid another delay. Thiokol, after an offline, behind closed doors meeting, changed their recommendation that it was OK to launch. Talk about wanting to be in the room where it happened! As a physician, I felt the same pressure in the world of corporate medicine. I was operating in a system that required more patient visits than I felt I could safely make. Interestingly (to be clear, that is a blatant euphemism), corporate medicine bureaucrats will tell physicians, “I am not going to tell you how to practice. You are the doctor.”
This is bullshit.
The moment someone tells me how to manage my referrals, how many patients to see per hour, how to communicate with my patients, where to send orders for laboratory or Xray studies, when I can see patients, and which patients I can or cannot see, they are telling me how to practice. I am going to manage the same patient for the same condition very differently if I have 15 minutes vs 1 hour with them. As physicians, we learn short cuts, short-hand, and cookie cutter management to make up for the lost time as we operate in this system that requires us to see more and more patients per hour each year. Believe me when I tell you that the physician is just as distraught and angry as you are that you had to wait one hour in the waiting room……that you only have 15 minutes for the visit…..that they cannot transparently tell you what the cost of the lab tests will be. They are surviving within the constraints of the system and hope you survive it too.
So, the TL/DR version of this blog post: Watch the docuseries Challenger: The Final Flight on Netflix. Then ask your doctor to watch it too.
At Culver Pediatrics Center, a board-certified pediatrician with over 15 years of clinical, academic, and quality improvement experience is your child’s doctor. I DO NOT answer to bureaucrats. If your child is not yet part of the Culver Pediatrics family, sign up in the email opt-in below to learn more about our boutique pediatric services.