Vacation...All I Ever Wanted

Signing Off but not Shutting Down

Spring break — a week off from making widgets. More time with family, and more time to let the mind wander freely. For me, that means more time reflecting on building better widget factories…or, better yet, designing a brand-new, widget-free system.

Here's what's currently top-of-mind:

1️⃣ “The Pitt”

Really enjoyed Season 1 of "The PITT." It was dramatized for TV and over the top at times (they crammed A LOT into a single ER shift), but it's probably the most accurate and raw depiction of what medicine on the frontlines feels like today. The show hit all the high notes -- patient frustrations, how overwhelmed the system is, friction between doctors and administrators, personality clashes, humanism, frailty, and the emotional toll of medicine. Noah Wylie was excellent.

Surfacing these issues brings a level of understanding that can drive change. The ER is a natural place to start. Next season, I hope the show explores the dynamics of other settings -- the operating room (why are ORs always dark and futuristic-looking on TV?), outpatient clinics, and on the hospital wards. The same tensions, triumphs, and failures exist there too and deserve a similar unflinching look.

For the time being, there's "St. Denis Medical," a lighter, more biting look at healthcare, but deeply insightful in its own way. The drama of “The PITT” was raw, but sometimes humor cuts just as deep.

2️⃣ Healthcare System Rebuild

If you had a blank slate and erased all memories of the current system, what kind of new care delivery system would you build?

I wrote about the "Hub-and-Spoke" model a few weeks ago, and I'm increasingly convinced that we're going about innovation backwards. Instead of retrofitting overhyped tech solutions, regressive policies, and ineffective payment reform onto the old model, we should admit that model is outdated.

The new model should be nimble, efficient, precise, and personalized. It should be designed to detect and intervene early, leverage expert level care early, and foster deep interconnectivity, constant feedback loops, and true 360-degree care. Instead, we keep manufacturing complexity to overcome the complexity we manufactured in the first place.

3️⃣ Healthcare v. Capitalism

Is it possible to treat healthcare as a capitalistic business and still create an evolved system that's innovative, investable, and good for patients? Does doing healthcare "right" come with a hard ROI ceiling that’s antithetical to stakeholder fiduciary duty?

As we approach the $5 trillion mark, I have to believe there’s room to have a nice business and do right by the system without profiteering. Healthcare as a business comes with significant principal-agent and moral hazard problems. The way to solve those issues is by fixing value capture inequality.

The rewards (upstream and downstream) should be enjoyed by those doing the critical work (doctors, nurses, etc.) and those who stand to benefit the most from that work (patients, communities, employers). Value extraction makes things expensive without any demonstrable benefit. Value redistribution promotes innovation, evolution, and better businesses.

4️⃣ Frontal Lobe

Will the Chiefs go O-line or D-line with their first-round draft pick?

Was that a glimmer of hope for the Blackhawks at the end of the season?

Is quantum computing the next big thing or vaporware?

Potential for Andor Season 2 — good or really, really good?

Rorschach and Dr. Manhattan from Watchmen are two of the most underrated Gen X pop culture icons.

What, you thought it was all healthcare, all the time?

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Ben Schwartz, MD, MBA

Editor-in-Chief, The Surgeon’s Record

Commons Clinic Senior Clinical Fellow