Only One by Pat Conrad MD

Recently on this site, we’ve gotten back into discussing the healthcare “team”, the fashionable term for non-physicians that is pushed by the media, academia, midlevels, nurses, and probably the cafeteria workers.

Of course, the AAFP has been seized by this garbage, which has been an integral part of its beloved Patient-Centered Medical Home boondoggles.  In 2015 they gathered with nursing organizations to cheer an IOM report (of course, those bastards) calling for an expanded team approach for nurses. Former American College of Physicians president, Steven Weinberger, M.D., who I’m happy to conclude, is an idiot, delivered this gem:

“We felt there is some problem with the concept of leadership, and I will say personally that I would love to see that word kind of go away, because it implies a hierarchy with a higher-up group and a not-so-high group … [the issue is] “who is the point person for a given patient’s care, and that is context-driven at a particular time.”

Since I was a kid, I’ve always been a fan of military history.  That included reading some fascinating, thrilling books on the Battle of the Atlantic in World War II, and the truly incredible hardships endured by German U-boat sailors.  In 1944, U-505 was captured by the U.S. Navy and towed through the Great Lakes to Chicago, where it rests today as a museum.  The submarines of WWII were small and so cramped that the entire boat had only one toilet, and they required “hot-racking”, where the sailors off-duty shared the bunks with those on watch.  Touring U-505, the visitor can see one exception:  the captain had his own separate bunk, with a small desk, and a curtain that could be pulled for privacy.  (pictured above)

U-boat life featured hours of monotony, mechanical failures that could spell doom, rotting food, bitter cold, and the constant threat of danger from air attack and depth charges.  Everyone on the boat had to function as a seamless team in a crash dive, to shave just a few seconds that could spell the difference between survival and death.  But even here, where teamwork was literally the difference between life and death, there was always one captain.  There was one person separate from the rest, responsible for the hard choices.  That’s how it had to be.  There was no numbskull speaker trying to redefine the hierarchy needed to accomplish time-critical, specialized tasks in an environment that was very “context-driven.”

Medicine is not the military, but this is one lesson that should not be ignored.  The physician, properly open to input from the supporting crew, is the captain and solely responsible for the call.  If the AAFP or IOM were in charge of submarines, they would pass every single inspection, and probably sink at the dock.


  4 comments for “Only One by Pat Conrad MD

  1. Dave Mittman, PA
    December 29, 2017 at 7:14 pm

    You don’t have a clue. The conversation is so One sided you will never grasp even the perception of the other.
    Start with this. The Captain of the Ship has an XO. You only want to groom Captains.
    Let’s dedicate 2018 to understand where we are really all coming from.
    I hope we are all up to listening in that manner.
    Happy New Year all!
    Only my personal opinions.

    • Pat
      December 31, 2017 at 1:48 pm

      Huh? No really, the captain’s bunk really was that small! As for grooming captains, on U-boats they just all grew beards until the patrol was over, so not really a factor.

  2. Perry
    December 27, 2017 at 2:50 pm

    Well gosh, if there’s a lawsuit, despite the “team approach” guess who’s gonna get named? Not the Nurse’s Aid, that’s for sure.
    And here’s a nice article in KevinMD about a Med Student who wants to insert her 2 cents into the “team’s” direction of care:
    Man, everybody wants to get in on the action, but no one wants the ultimate responsibility, it’s left to the poor sucker doctor.

    • RSW
      December 27, 2017 at 3:14 pm

      Loved that article by Princess Snowflake. According to her, one of the team’s responsibilities is finding “affordable yoga studios” for patients.


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