The Surgeon recently read another New Yorker piece (Big Med) from the renowned surgeon/writer Atul Gawande. This particular piece makes the startling claim that medicine would be better off (more efficient, cheaper) if it started to emulate the kitschy, impersonal chain restaurant Cheesecake Factory. Yes, the same mega-chain notorious for the massive portions and enough calories per meal to fuel a man for three days. Again, Cheesecake Factory. The premise being that American medicine could stand to take a few pointers from one of the leading contributors to the national obesity epidemic.
Initially the Surgeon suspected the piece was meant as satire, some sort of ironic parody of Gladwellian cross-analogizing of disparate disciplines. But Dr Gawande is a serious man. He has always written with a naif-like earnestness that makes him especially compelling. So the Surgeon read the damn thing again. And again, it is clear that the way of the future (per Gawande) lies via the corporate business model of the Cheesecake Factory. The Surgeon is stupified.
Apparently we would all be better off if large, for-profit conglomerates like Kaiser and the Cleveland Clinic ran things. All the doctors would be employees and the major medical equipment suppliers and pharmaceutical industries would be beholden to the bargaining power of regional healthcare monopolies. This is the Utopia that awaits us.
Dr. Gawande envisions a future where Eagle-Eye Big Brothers in out-of-state cockpits actively second guess the decisions of local, on-site physicians via hidden cameras and patching into the EMR. He positively drools over the idea of replicating the Cheesecake system of "rating" each dish as it comes off the prep line for surgery and medical care. The Surgeon can just imagine, before visiting with family and loved ones, checking in with his "unit supervisor" after a gallbladder removal to make sure his technique received at least a score of 8 or whatever the hell the metric ends up being.
The Cheesecake Factory. Cost effective and delicious. Doctors as line cooks.
The sad part is that physicians are to blame for all this nonsense. Too many years of selfish bickering and self-interested clinical decision making (unnecessary joint replacements, cardiac caths sans indications, incestuous/corrupt relationships with Big Pharm/medical suppliers), along with a more recent phenomenon of sagging work ethic (I don't wanna take call more than three times a month), and financial motives (I wannna be a dematologist because I owe 250 grand in loans) have led to this position where the leading insider physician health policy wonk can advocate for assembly line medicine with the concommitant deprofessionalization of doctors and be universally lauded rather than laughed out of the room.