Passing The Torch: Out with the Old. In with the New

The Doctor Off the Coast of Vietnam 1970

 The Phantom flew down to North Carolina to attend the retirement party for his brother last night. His brother had been chairman of a department at a famous medical school for nearly 30 years and five years ago had been bumped upstairs to administration of the group of faculty doctors who provide services for the university hospital. 

His duties as the president of the faculty doctors crossed the divide of making sure the services rendered were of high quality from the medical point of view,  and making sure everyone got paid as much as circumstances and merit allowed, i.e., the financial end of things.
When he started his job, he found there was a financial man already in charge of the money end, negotiating with insurance companies for the best fees, being sure doctors got paid a fair wage for a fair day's work, and no more.
The financial guy, a MBA type, was not happy to have a doctor asking a lot of questions about how things were done. Doctors are not supposed to understand fiance. Render unto Caesar that which is Caesar's.  The MBA found many of the questions from the doctor, "embarrassing." 

The phantom's brother had the idea he could learn anything, and he would not accept the proposition that to be a team player was to ask no uncomfortable questions.

This conviction, had, in the past, turned out to be naive. The brother had been asked to serve on a board of directors of a company which made medical devices. It paid $50,000 a year, or something in that neighborhood, and all you had to do was read over a set of documents and attend board meetings. At his first board meeting, brother asked a few questions about the losses sustained by the company, which had over the previous five years,  lost about three million dollars. The chief financial officer brushed aside these questions,  and they all moved on to new business, which was to vote each of the board of directors a $50,000 bonus for that year, on top of their usual stipend. How, asked brother, could you vote an increase to the board when the company had not turned a profit, in fact had lost money? The directors smiled indulgently, and said, "You just don't understand how things are done in business."
Which, he took to mean, "We have the power to rape this company and the stockholders, and we will do it as we please."

Brother resigned soon thereafter.

"I guess I'm just not cut out for the business world," he said.

Now, Phantom's brother faced retirement in his faculty group job  because he had passed age 70. The faculty group organization had a rule requiring everyone to retire at this age. Nothing personal:  It was supposed to insure fresh blood, fresh ideas continued to infuse the organization.

The question is: Do organizations benefit so much more from young minds and "new" ideas they should automatically purge old minds?

At the beginning of the Civil War, the old war horse who commanded the Union armies, Winfield Scott,  was shoved aside as an old goat unable to guide the armed forces through the coming onslaught.  When Ulysess Grant consulted him, Scott said the fastest way to win the war was to secure control of the Mississippi, cut the South in half and then turn East and tighten the noose. The general was shoved aside, but his insight was sound, and it proved the winning formula, in the end. Before the North finally returned to this plan, a whole rogue's gallery of younger generals stumbled through terribly mismanaged battles, wasted untold lives and waved their hats to adoring ranks of enlisted and civilians, riding along, their un gray hair streaming in the wind.

Eisenhower, who as President,  looked old and tired as he fumbled through passionless speechless,  delivered in a high pitched monotone, had seen the wonders of the Autobahn, as he raced across Germany during the war. He built the interstate highway system. He warned against the emerging "military industrial complex"  which he could see coming and which did not bedazzle him. He could see when forts had become obsolete, when weapons systems were being built for no good military reason, but only to fatten the wallets in a particular Congressman's district.

These old, tired men knew some things, but were ignored, disregarded because they were old and what could they know which would be of value to the new, emerging world?

The Doctor as Older Brother circa 1954

In his departing valedictorian, the Phantom's brother noted that over the course of his tenure the greatest advance in the provision of services to patients was not the advent of the MRI or the CT scan, but something much simpler.   As was true at most university hospitals, doctors from the surgical service or the medical service could sign out X rays and cart them off to a doctor's office, or a ward, or an operating room, where they often moldered, got lost and became unavailable to any other doctor involved in that patient's care who needed to see the films. 

So the department of radiology decreed all films had to remain in the department of radiology. This met with considered objection, but eventually, the rule held and the teams of surgeons, internists, pediatricians built "radiology rounds" into their day, and they gathered around the view boxes in the radiology suites where they presented the cases to the radiologists who went over each film with the doctors caring for the patient, pointed out things the surgeons or the pediatricians could not see and very quickly radiology rounds became so central to the quality of care of patients nobody could understand how the hospital had managed to function before this practice had been initiated. 

This gathering of minds, where surgeons and internists and radiologists saw each other daily, face to face, enhanced the quality of care, not to mention the espirt des corps  of the hospital in ways nobody could ever measure. 

But it was abandoned when computer technology made X rays appear on computers on the wards, in the operating room suites and on tablets carried by doctors on rounds. 

Now, the radiologists sit alone in their offices, reading films, surgeons look at the films on the wards, intensivists never leave the ICU, and hospital doctors have returned to the old ways of isolation. 

Beyond that, doctors leave patients mid-crisis when shifts change, and doctors are no longer paid by the patients or by their patients' insurance companies, but by the companies which hire them.  An odd, if not perverse, set of incentives has emerged.

All this is unappreciated by new doctors and new MBA's who have never seen how a hospital could function when there was cross pollination of surgeons, internists, pediatricians, critical care doctors, all swirling through the same place--the radiology suite, like herds coming to feed at the same water hole. 

Oh, well.  The torch has been passed. The new crew, the young and the vigorous are taking up the flame and carrying it forward. 

They will make their own mistakes.