Can I get a “what what” from my fellow Star Trek fans out there? While I am no Trekkie, I am a fan and have watched all the old shows and movies, etc. You may have noticed my admiration when I came up with the Administribbles comparison. Well, here is another one for you. The Kobayashi Maru is a training exercise designed to test the character of cadets in the command track at Starfleet Academy. The test’s name is used to describe a no-win scenario, or a solution that involves redefining the problem and testing one’s character.
As physicians, we are going through our own Kobayashi Maru. Let me explain. We have put ourselves into a no-win scenario. In the original Star Trek example, the cadet has to rescue the civilian vessel Kobayashi Maru in a simulated battle with the Klingons. The disabled ship is located in the Klingon Neutral Zone, and any Starfleet ship entering the zone would cause an interstellar incident. The approaching cadet crew must decide whether to attempt rescue of the Kobayashi Maru crew – endangering their own ship and lives – or leave the Kobayashi Maru to certain destruction. If the cadet chooses to attempt rescue, the simulation is designed to guarantee that the ship is destroyed with the loss of all crew members. In our scenario, our patients are in the neutral zone and the hospitals and insurers are the Klingons or Romulans or both. Any attempt at fixing our scenario, in today’s healthcare model, ends with our own destruction and the demise of our patients.
In order to beat the “game”, Captan Kirk reprogrammed the simulator so that it was possible to rescue the freighter. So in essence, he never really faced the no-win scenario. But Kirk states he doesn’t believe in such a thing as a no-win scenario and the beauty is that despite having cheated, Kirk was awarded a commendation for “original thinking”.
The way the healthcare system is set up now, it is unwinnable. Since physician organizations are impotent and the administrators and insurers have control, we cannot beat the game as it is. But, like Kirk, I do not give up that easy. The only way to reprogram the system is to walk away from it and practice medicine on your own terms. My best friend did this by doing a osteopathic clinic only. It is flourishing. I did this by opening up my own direct primary care office. It is flourishing. Call it original thinking or call it desperation, it doesn’t matter. I am on the other side now and telling you there is a way to win the medical version of the Kobayashi Maru. You can’t game the system (by fudging numbers and hiring teams) but you can change the game.
You have no other options and trust me, the Borg is on the way. Actually, they are already here.