It is tough playing man-to-man when coaches on the sideline keep insisting your team plays zone.
Such is it with health care.
For doctors, the man-to-man defense never ends. Stay with them. Glue to them. Move with them. Run with them. Defend against the bounce pass, or the dribble to avoid the admission. Hands up! Watch their waist, ignore the head fake. You shift your coverage to accommodate their needs. One on one, mana-a-mano.
But for the business of medicine, it’s all about the zone. Defend the admission basket against as many people as possible with the least number of defenders. Stay in your position. Work it 2-1-2, 2-3, or if you’re really adventurous: 1-2-2. Stick to our limited number of defenses using small variations with the same number of people. Keep your hands up so you look bigger than you are! Don’t let them near the hospitalization goal! We’ve seen all their plays and watched all their moves with our electronic record, so let’s win this game! If the patients move left, you move left. If the patient moves right, you move right. Anticipate! How hard can it be?
When you only look from the sidelines, everything seems obvious.
But what happens when the patients change tactics? What if the patient’s psyche or medical issues don’t follow the typical playbook? Will our zone defense apply enough pressure on patients to affect change? Or will it apply too much pressure upon them, causing them to drop out of the game? Who wins then? When the bench is left too limited and the game extends too long, will the exhausted physician defenders be able to convince the coaches that there’s a better way to play defense against these admissions?
Every frontline health care professional knows that the health care game is played one patient at a time and on one court at a time. And yet, we see more courts being built and technologic advances being funded as spectators are sold on the illusion that doctors can suddenly play multiple games on multiple courts with multiple patients with an infinite game clock while never dropping the ball. Even now, the storyline remains: we cannot afford to play health care one-on-one.
So the players become confused. They wonder (more than ever) who they’re really playing for. The players wonder why they continue to see more money than God spent on the courts, the lights and the corporate skyboxes instead of the critical players themselves. Will our health care game be won by building more courts or by actually playing the game? How many administrative coaches do we need?
Most of all, since its now come down to money versus care, how will we ever put doctors, hospitals and patients on the same team?