Medicine’s for the Birds

In the world of sports, Boston is hot—arguably the sports capitol of this country, if not the world and universe. Consider recent events. The Red Sox now have two world championships under their belts and have emerged from the 86-year Curse of the Bambino. In a clean sweep, the Sox mowed down the Colorado Rockies and made the Red Sox Nation forget the decades of misery and frustration. Who knows? If the Rockies had put up a fight, ACR members could have danced in a victory parade near the convention center during our meeting.

Boston’s success does not just involve the boys of summer in the hallowed confines of Fenway Park. Out in Foxborough, the Patriots are a genuine dynasty and, at the moment of this writing, are undefeated. Boston College is number two in the Bowl Championship Series (BCS) ranking, a place usually reserved for Notre Dame—its counterpart of Catholic athleticism. The refs in the NBA (under the microscope and hopefully wary of blowing their whistles too often) are about to toss the ball in the air for the first tip-off as Bean Town wonders whether the restocked and revitalized Celtics (Isn’t free agency wonderful?) will make a run for the title this year.

While anyone from Boston can enjoy the current success of its teams, victory will not be complete until the Celtics are back on top. The Celtics were the ultimate dynastic team and, in the era of Bob Cousy, Bill Russell, and Bill Sharman, were wonderful. Ultimately, those lads were almost too good as they ruled the hardwoods amidst the famous fog of Red Auerbach’s cigar smoke. To me, it was the Larry Bird era that was the most exciting and, indeed, the most relevant to modern medicine.

Basketballs and Stethoscopes?

Larry Bird and medicine? How they are related? The answer concerns the attitude that Bird brought to the court and the wisdom of his coach, K.C. Jones, in allowing him to express it. The question I want to ask today is simple. In medicine, are we being coached like Larry Birds, but will we be given the ball so we can win the game?

There is a story told about the relationship between Bird and Jones. Jones (himself a Hall-of-Famer) guided the Celtics to NBA Championships in 1984 and 1986. It is easy to think that anyone who had Bird, McHale, D.J., and The Chief in his arsenal would have been a winner, but there has been a slew of teams chock full of talent that never went very far. Consider the New York Yankees with their annual payroll equivalent to 40 endowed rheumatology chairs and their dying-swan act against the Cleveland Indians.

According to this story about Jones’ coaching style, near the end of a close game in Seattle, K.C. Jones called his team together in a tense time-out. If nothing else, Bird was confident—even brash. Before K.C. Jones could say anything, Bird took charge. Scowling at his teammates, he shouted, “Give me the ball and get the hell out of the way.”

K.C. Jones told Bird to shut up. “I’m the coach, Larry. I’ll call the play.”

“O.K., Coach.” Bird replied, chastened. “You’re right. You call the play.”

To which K.C. Jones said, glaring at his team, “Give Bird the ball and get the hell out of the way.”

As unassuming and soft-spoken as K.C. Jones appeared, he was a brilliant man. If he knew that his star felt he could sink a three-pointer at the buzzer, he did not feel constrained by a set play with a perplexing array of Xs and Os. He had faith in Bird’s shot and was willing to trust him.

The Boston Garden is a forgotten relic, and another era of Celtic triumph is only a dream at this point. I cannot worry about basketball but I can—and do—worry about the state of rheumatology as it reflects on the state of medicine in this country.

Too Much Coaching Spoils the Game

Are providers treated as champions? Does society have the faith in physicians and other healthcare professionals to just give us the ball? Or, does society think that it has to chart every move on a chalkboard to tell us exactly what to do, how to do it, and when to act?

When doctors do not succeed, does society fault the doctors or does it fault itself for a cluttered and ponderous game plan that prevents the innovation necessary for success—whether in the heat of a hard fought game or in the struggle to improve patient care?

In short, are we treated like Birds?

I have been in academics for almost 40 years and am sometimes incredulous at the volume of rules, regulations, and demands for documentation or disclosure that have proliferated to govern the practice of medicine and especially the conduct of research. Many of these regulations are welcome, necessary, and appropriate to correct abuses that existed in the past. It is absolutely essential that patients be informed of the risks and benefits of their treatments and participation in clinical trials. Confidentiality is also essential—although, as my hospital ethicist once told me, “Face it, confidentiality is impossible in a hospital.”

No doubt, as in any human endeavor, there will be people who try to break the rules or take shortcuts and violate common sense in research or patient care. However, concerns over that small minority should not rise to the level where rules oppress everyone, stifle creativity, and take the joy out of clinical and academic pursuits.

Like any complicated enterprise, organized medicine is now encased in an enormous bureaucracy that is increasing costs, limiting care, and—regrettably—discouraging people from pursuing what is one of the most personally rewarding endeavors imaginable: To give life and help another human being. For that endeavor to prosper, I think that it is time for those in organized medicine to back off from their apparent intent to regulate everything.

By the time you read this column, the 2007 Boston ACR meeting will be over, and I am sure that it will have been a great success. While scientific meetings are about progress and a look into the future, they should also be about the past. Americans need not go back to the time of the Revolution to learn about history. They need only go back 20 years and study what made K.C. Jones a masterful coach. Jones recognized genius and, when necessary, he was willing to toss his champion the ball and tell the others to get the hell out of the way.

I think it is time for those who oversee medical care in this country to try a new approach: Ask your players what works and, whenever possible, sit on the bench and let them play the game.

Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.