The Whole Truth, The First Time                        April
15, 2013

(Don’t forget to mail your annual contribution to Medicare, Medicaid,
the VA System, military health care and health care for Indians, government
employees and members of Congress. 
Due today! Almost 50% of health care costs in the country are paid for by
you! Plus you get to pay for your own and you do! Read David Goldhill’s book
called “Catastrophic Care”)

By

Leonard Zwelling

            First
it was supposed to leave at 9:54 AM. Before we even left for the airport it
became 10:30. By the time we got to IAH it was 11. After waiting in line at the
gate, like the cattle we have learned to become in the TSA line-up (does this
look like victory to you?), we boarded in 5 groups using a self-serve system of
ticket scanning, moo-ving through gates even Temple Grandin would consider
unwelcoming, to enter the jetway. We were lucky in that the crew had no
electric prods. The plane left the ground for Hawaii at 12:08 PM, well over two
hours late.

            Before
you ask, it was a beautiful crystal clear day both in Honolulu, from whence the
plane came and in Houston. The plane arrived late from Honolulu and the crew
took over an hour to prepare the cabin. During the gate wait, I sauntered over
to the desk where the United staff was busy clicking keys on computers, but
servicing no one as the space in front of the counter was vacant. I politely
asked what the problem was.

            It
seemed that someone had taken ill over the Pacific during the inbound flight
from Hawaii. This necessitated an unplanned stop in San Francisco to administer
medical attention. I got back in line next to my wife and told the passengers
around me what I had learned.

            “Why
don’t they just tell us that?”

            Why,
indeed?

            Five
minutes before takeoff the flight crew came through the cabin of the 777 and
let us all know the cause of the delay, something they had known for hours, but
kept from us as we grazed in front of the gate for an hour in ignorant bliss.

            This
illustrates a critical point first taught to me by Vice President for Public
Affairs Steve Stuyck many years ago when I first had to handle research
“mishaps” that found their way into the press.

            Steve
said, “When it comes to bad news, get it out, get it all out and get it out the
first time”.

            In
situations when unpleasant and often unanticipated occurrences arise, those in
charge are obligated to make all those affected by the mistake or untoward
event aware of the problem with which they all have to contend.  If the Stuyck rule is followed, bad press
is not avoided, but all imaginary causes for problems are eliminated from the
minds of those affected and the maximum cooperation possible is virtually
guaranteed through the trust leadership shows in those being led. By the way,
the “bad” story goes away quickly as well.  See what happened when Dave Letterman admitted his
indiscretions and the fact that he was being blackmailed on the air. Three days
later, it was all history.

            On
this flight to Hawaii, United’s staff flunked Stuyck Communications 101.

            For
weeks we at Anderson have been told that there is a crisis. The operational
revenues are down, in fact below breakeven. The 8% growth anticipated in the
last budget is not close to being reached. What the heck happened?

            Many
of us went to the Faculty Senate-sponsored forum on April 4 hoping to find out.
We did not. There is still not an actual accounting of the total revenues vs.
total costs of running MD Anderson and the precise amount coming in from
various sources and being used to support various projects. In short, the truth
is still not out there, even partially.

            The
leadership seems to believe that if the clinical faculty just put out a bit
more, the problem would vanish. But that’s only if you think the problem is
volume-based and that capacity has not approached its limits. But no one
believes that either of these things is true. We know for sure that at least
once a week the hospital is declared full and more and more of my clinical
colleagues are telling me that the kind of patients we can uniquely assist or
who could assist us in our clinical research mission are harder and harder to
come by. The complex patients hoping that MD Anderson can make their cancers
history take an inordinate amount of clinic time to work-up. Despite all the
work, we may not affect the natural history of their disease or even be able to
offer them a clinical trial for which they are eligible if they are of poor
performance status.

            If
the leadership really wants the cooperation and extra effort they seem to think
they deserve from the faculty, that leadership is going to have to be far more
transparent and forthcoming than was the case at that Faculty Forum. If they
aren’t, the faculty and the outside world might all think the worst about what
money is coming in and where it is going.

            When
people don’t know the truth, they may well make it up. Made up stories for the
origins of budget problems will never fix the problem. Tell us the truth. How
much is coming in and from where? How much is going out and from and to where?
And how much of all of this has been made public in a fashion that is credible
by people deemed trustworthy? Clearly, not enough–yet.

            My
guess is that the administration is struggling mightily to support the several
new and costly programs that constitute the Moon Shots. It is also unclear
whether or not we are really making any spending money from our various
world-wide affiliations. It is unclear as to whether the IACS is gathering much
of its support from the clinical operations and if it is, when it is
anticipated that IACS will become self-sustaining.  These are important questions requiring straight-forward,
clear answers. Give us the truth, the whole truth. We can take it, but only if
it is true.

Leonard Zwelling