What I'm Reading (Aug. 10)

By Chuck Dinerstein, MD, MBA — Aug 10, 2023
Is the “moral injury” experienced by physicians self-inflicted? Even chocolate is a monopoly No Brown M&Ms The power of checklists
Image by succo from Pixabay

The corporate take-over and consolidation of medicine is well underway. It has been two or three years now that the majority of physicians are employees rather than self-employed. Are the rising tide of corporate management of medicine and rates of physician burnout related?

“Military psychiatrists use the term to describe an emotional wound sustained when, in the course of fulfilling their duties, soldiers witnessed or committed acts — raiding a home, killing a noncombatant — that transgressed their core values. Doctors on the front lines of America’s profit-driven health care system were also susceptible to such wounds, Dean and Talbot submitted, as the demands of administrators, hospital executives and insurers forced them to stray from the ethical principles that were supposed to govern their profession. The pull of these forces left many doctors anguished and distraught, caught between the Hippocratic oath and “the realities of making a profit from people at their sickest and most vulnerable.”

Perhaps a bit of hyperbole, perhaps not. From the New York Times, The Moral Crisis of America’s Doctors


Once you use an economic lens, the consolidation of American industries looks a great deal like the monopolies of one hundred or more years ago. Consider the monopoly on candy.

“Hershey’s and Mars do 75% of the chocolate revenue in America. It’s kind of monopolistic, almost. Like if you have a successful chocolate company they’ll just buy you or just bully you so you don’t get shelf space. These guys just own all the chocolate space, and they don’t innovate.”

From Matt Stoller, Is the Chocolate Monopoly Under Seige?


Perhaps you remember the story about Van Halen’s concert contract stipulating that there were to be M&Ms in their dressing room but that all the brown ones had to be removed. Was this a demand, or as a later telling of the tale suggested, a means of checking whether the contract had been read? It’s time for some revisionist history.

“The only conclusion I can draw from this is that the M&M test is almost certainly what it seemed to be in the first place: a way for some of rock music’s biggest egos to make a statement about just how demanding and brash and obnoxious they could be. In the 1980s, there were rumors that Van Halen’s candy demands were an attempt to emulate KISS, which (supposedly!) had banned red M&Ms due to the red dye scare of 1976 (a real thing) or because Van Halen had once played an especially good gig after eating M&Ms that just happened to not include any brown ones. Those stories seem plausible, as does the possibility that the band just wanted to give the impression that they were kinda assholes—WE’RE CELEBRITIES, DO AS WE SAY.”

From Snack Stack, the substack posts of Doug Mack, In Search of Van Halen's Brown M&Ms


I use checklists as a memory aid, a written version of the Kanban Boards associated with Toyota’s kaizen philosophy. For those who didn’t understand a word in that last sentence, you can read more about kaizen, and it will be worthwhile here.

“I always considered a checklist, a checklist, so I was interested to learn the distinction between two types of checklists: Read-Do and Do-Confirm. … A Read-Do checklist might be prepared in advance for several potential possibilities. …A Do-Confirm checklist is more of an aid to memory to make sure nothing gets missed.”

From sketchplanations, Read Do, Do Confirm

Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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