Dr. Kobayashi Maru


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.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  1 comment for “Dr. Kobayashi Maru

  1. Doctorsh
    July 8, 2015 at 2:24 pm


    That’s why I went DPC way back in 2008.
    Now we need to convince our colleagues still in the no win scenario how to reprogram their careers.


Comments are closed.