Did Atlas Really Shrug?
So as my transition to compact membership-driven care starts I am wrapping up some details; refills and messages are mine still for another month. Today I declined a refill of a med that must be renewed every six months by clinic policy. She was obligated to schedule with us, and she did schedule to see the midlevels with a great deal of complaining – she wanted the meds, not the visit. It was 7 months since her last visit, and 12 months before that, and she has been getting refills essentially straight through, sending messages (over 20 in the last year and a half.) This is why I am quitting. The income from the two visits doesn’t come close to offsetting the costs of staff time, overhead, risk, and my time that this person represents. She deserves the box store style care she will get – but she will complain nonetheless. I wondered at some point in the past in situations like this if this type of person would regret taking us for granted and driving this change to take place. Now? I don’t think so and I don’t care. Maybe I am getting wiser, maybe more jaded, and maybe I am just listening to Atlas Shrugged again.
For those who have read Atlas Shrugged in the past, I recommend the 62-hour listen to the audible book version. Those that have not read it I strongly recommend it – it will not fit with anyone’s beliefs perfectly, but anyone can see the wisdom and the warning in it. I was reminded of the book when shrinking my practice down to a more manageable size. Several times my office manager told me that a patient had said, and he quoted them, “He can’t do that! He has always been my doctor!” One of those who said that owed over three thousand dollars and had not paid anything in years. She had the need of a doctor, but not the ability to pay, so she assumed she would get a lifetime of free care from me and I would magically make it all work.
So it turns out I can do that. I can quit, I can leave, I can move on with my life as I see fit. I can shrug, and tip the earth off my shoulders, and stand tall again.
The world has for so long used our desire to help others as a trap to keep us enslaved. Yes, doctor, I see you want vacation, a 40 hour work week, a decent income. But you see there just isn’t any money left after all the sick people, the administration, the CEOs, the staff. And you CAN”T leave just yet. There are sick people, dying people that need you. And we need you to produce the income that you will see a tiny percentage of. We cannot make it without you.
I leave with two remarks: The first is the most important phrase of the book. Memorize it, and see how often it manifests in your life.
“From each according to their ability, To each according to their need.”
The second remark: you will get to a point in the book when a radio broadcast is hijacked and a man gives a speech. Skip that part, it’s like 90 pages of redundancy.
I’m still laughing at the comment “desperately in need of an aggressive editor”…
Okay, so Galt’s speech was a bit long, but credit Rand for wanting to Get. It. Right. by covering every angle with overlapping, converging fire (and I utterly reject her atheism). The famous D’Anconia Money Speech is more memorable, and downright brilliant.
I read “Atlas” in residency, and it was far and away the most important book in my medical education. I’ve read it 5 times through, and had I read it before medical school I think I would have avoided this profession altogether. As Rand highlighted the true irrational core of human evil, practicing medicine shoves it in one’s face, that participation in a corrupt industry is embracing the evil of self-harm.
I read it first of several times before choosing to go into the ruined profession. I had long been revolted by the scabrous way that it draws in many of the worst people to it, who ruin those who they do not enslave. But there is something there which is FOR me, where I can shine with my own inner light of excellence; all the rest be damned. LIFE is an inexplicable gift that needs no further explanation. It is to be a cause of delight and joy, and to be in service of. A quote that I can’t find in the book, a character states, “I am about life. What then do my enemies serve?” I actually draw some religious principles from Alice Rosenbaum, a Russian Jew, who became Ayn Rand the atheist, although I am neither. L’chaim, Jews say, to LIFE! Service in honor of this gift is all that I need to do. That’s what brought me to this thankless order.
A tremendous set of ideas, encased in a massive volume in desperate need of an aggressive editor. Ultimately Rand is at her best as a dystopian humorist at the rank of Hunter S. Thompson in her caricatures of the unspeakable grifters who are the villains of her world and ours. One of the great heroes of the book is Dr. Thomas Hendricks, who left medicine to stop being a slave to those who can create nothing but ruin everything. I have not intended to model my life and career on the protagonist John Galt; rather, common moral choices have occasioned to bring my path into a comparable one to Galt’s. Bullies frighten me; I flee from them and will not follow their methods. This may have checkered a stellar medical career as seen from the outside. But I sleep well at night, that makes it worthwhile. Do listen or read, and roll your eyes at this writer’s prolixity. It’s mostly worth a go. Read ANTHEM, a much more crisp and short book, first.
There is an upcoming blog which is his best speech. That doctor has a tiny “screen time” in the book, but a large impact.
Doctors must take care of our patients, but our patients should have the decency to take care of their doctors, too (by showing up for appointments and paying, perhaps).
When there are no longer effective Principles held in common in a society- dignity, respect, temperance, cordiality-then Rules attempt to fill the Void. Little minds love Rules, as they require the presence of an Authority to adjudicate these rules. If I do not like an informed medical decision, I can appeal for punishment of the doctor by his superiors, who have less skill and interest in medicine but more in “customer service.” When right and wrong conflict, they ask, how can we find a middle ground?
✔️✔️✔️
Wow, that’s really good, Steve O’! I like it. “Little minds love rules b/c they require the presence of an authority for adjudication”. I can use that line and will always give credit when/where due, sir.