DOCtalk by Dr. Gregg 9/9/11

An Operational Luddite

Tech-oriented I am. Born geek I was. So how bizarre it feels to note that today I declare myself a Luddite.

Not a traditional Luddite in the current sense who eschews all things tech and opts to forego modernity in the information age by going about sans smart phone, without an e-mail address, and reading books that really are books … you know, made of paper and ink. (Really. Real ink!)

And not in the historical sense from the earlier backlash against the Industrial Revolution in the late 1770s and early 1800s when mechanized looms, or “stocking frames,” threatened to bring mass chaos to the world and the rather mythical Ned Lud (later exalted to “King Lud” or “Captain Lud”) first destroyed such a loom in a still-unclear fit of rage or passion.

No, I like my tech. I cringe when my power goes out, when my smart phone battery starts flashing less than 5% battery remaining, or when I’m assaulted by some insurance company multi-page form that I must complete … gulp … by hand!

My “Ludditious” nature centers around the current trend for all things healthcare going conglomerate: hospitals buying up solo and small group practices willy-nilly; ACOs appearing almost like morel mushrooms out of the droppings of not-so-distant failed doctor-hospital coops of the late 20th century; HIT talking heads portending the end of the small “onesy-twosy” doc practices.

I’ve worked in large institutions, and even now, with some of my other current dealings, I have to try to work within large organizational frameworks. Much, if not most of the time, I personally find these “frameworks” to be more spider web than scaffolding. Navigating many larger bureaucracies has often reminded me of advanced trigonometry. I know some folks get it with ease and grace, but it’s akin to an Escher landscape when I look.

In fact, I mentioned to my little “onesey” practice staff (all three of them) yesterday that I’ve come to believe that any group of people beyond about five in a work environment just seems to have a pall or haze of bureaucratic entanglements that seem virtually unavoidable. And the really weird part for me is that individually, many — even most — of the folks who make up said bureaucracies are all good folk with good intent. But get five-plus people involved in an endeavor and you can just watch the red tape, boring meetings, and meaningless uselessness start to almost magically sprout, just like morel mushrooms from the dung – overnight.

Being a small business owner is tough, no doubt. Sleepless nights wondering if you’ll make payroll in the morning, stretching yourself micron-thin, lack of certain freedoms of escape — all weigh notably on the “con” side. But if I can keep my head above the red ink water, I will proudly try to maintain my “Operational Luddite” status and avoid the ACO / hospital-acquired / multi-provider group bandwagon.

The cons for this entrepreneurial work style are there, but the “pros” are just too fun. We can make a decision, act on it, decide if it works or not, and make a new decision that builds upon the successes or failures of the prior one – and we can do all that without one single meeting, PowerPoint, org chart, or study. Heck, I don’t even have to ask anyone for permission, no less a board or committee. I can make experimental choices – some mistakes, some huge successes – and then redirect as soon as the needs change. Snap — just like that.

So, if all of healthcare is going to conglomerates, to ACOs, and to “big-buy-the-small” corporations, I think I’ll just have to accept the fact that, at least in one sense, I’m a Luddite, an “Operational Luddite.” I like being a “onesy.”

From the trenches…

“Bureaucracy is the art of making the possible impossible.” – Javier Pascual Salcedo

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).