Managing Health Care,
Managing Doctors; These Two Things Do Not Go Together But They Should


Leonard Zwelling

         President Obama has just appointed an Ebola Czar, Ron
Klain.  Mr. Klain is a highly respected
government manager with good relationships in the executive branch and on
Capitol Hill.  This would seem to make
sense.  But, not to me.

         The problem with the Ebola Crisis is that it is a crisis in
the first place. As of now, there are three confirmed cases in the US plus those transported here from West Africa. I think the total is 8 thus far. Are
there likely to be more? Probably, given the porous nature of our borders, the
fluidity of jet travel and our unwillingness to shut this down—right now!

there should be screw-ups at the African end of Ebola’s pipeline to America is
not all that surprising.  The
infrastructure there is being overwhelmed. Even supplies from the West that
make it in country may sit on docks and never get to their intended
beneficiaries. This is not unexpected even if disappointing (and expensive for
American taxpayers). The cultural barriers created by belief systems regarding
the handling of the bodies of the deceased are also distinct problems that the
Ebola Czar is unlikely to overcome in the short run. The real issue is how can
we get a handle on this “crisis,” make sure it is indeed in the short run, and
not have the Ebola Virus become Time’s Person of the Year.

         Before we point fingers at the screw-ups in Africa, what
about the ones right here?

the CDC should never have tried to assuage the fears of ordinary Americans when
the first Ebola case was identified. Instead of spinning a web of false security, the federal government should
have tried to convince us that this is a real problem and that critical
agencies like the CDC and NIH have the real answer because they have been
preparing for this for a year or more. If the latter is untrue, say so. There
is no substitute for the truth even if the truth is “I don’t know.”

why did the federal government not demonstrate some expertise, leadership and understanding
by sending some CDC people to Dallas at the instant the first case was
identified to show the nation that the federal government is on the case and
helping local officials? Katrina clearly taught these folks nothing.

change the name of the company hired to sterilize the living quarters of the
infected to something other than “The Cleaning Guys.” This sounds like the fate
of the city of Dallas is in the hands of people who work for the Mafia, were
walk-ons in Pulp Fiction or are part of a skit on SNL with Dan Ackroyd and
Steve Martin.

can we get some credible docs in front of the TV cameras who actually still
treat patients with serious and lethal infectious diseases, especially those infections
emanating from Africa, and let them lead the country’s response via science,
medicine and the truth? Politics is not the solution here. Is it too much to
ask to ask real treating doctors about diseases?

answer apparently is YES for every place I look of late when it comes to
medicine, some bureaucrat whose major interaction with the health care delivery
system is his last rectal is spouting “information” that we are supposed to
believe. Where is C. Edward Koop when we need him? Hell, why don’t we even have
a Surgeon General?

again, this White House has a propensity for appointing mediocrity and giving
it a platform at the precise time expertise and gravitas is most needed.

I said, this has become the norm in medicine. Look at Anderson. The President
is not even a cancer doctor. The Provost is but seems unwilling to take a stand
on anything or be about anything and the Chief Medical Officer wants everyone
to just get along. Then there are the law and finance guys who seem to be the
ones really in charge pushing the clinicians to do more with less in the way of
infrastructure. I can’t wait until they introduce the new EMR. Can you? No
worries. The EMR Czar at Anderson will see your clinic patients for you while you do your mandatory two weeks of training on EPIC. Not!

of a Health Care Czar or an Ebola Czar, how about a doctor? How novel!

and I mean a real doctor. Not one like me who really just plays a doctor on TV.

there is one thing that I miss about my old job as VP, it is spending the day
trying to service the needs of those really treating cancer patients and doing
clinical research. Dealing with the bureaucracy, federal regulations, computer
systems and MD Anderson (or Legacy) forms and leadership, I miss like my last
back surgery.

have quoted my psychiatrist from DC in the past when she responded to me asking
her why psychiatrists needed to be medically trained.

bring people into this world and they help them out. They can handle most of
what happens in between.”

who should be the Ebola Czar? A Democratic Party operative who was the chief of
staff to two Vice Presidents or a real doctor? That answer seems easy, but
apparently not for Mr. Obama.

decisions seem to confuse the Board of Regents as well.

Leonard Zwelling