Earlier Thoughts

Sunday, September 26, 2010

The Greatest Show on Earth

“We didn't reinvent the circus. We repackaged it in a much more modern way.”
Sometimes the circus comes to town.  I used to see this more often when I was a child.  The posters were put up on fences and telephone poles announcing the lions, tigers, and bears (oh my). 
Once my mother actually took my sister and me to a circus in Honolulu, the city of my birth and early childhood, which was the billed as, “The Greatest Show on Earth.”  This claim would not pass the Federal Trade Commission advertising standards of today, and certainly didn’t pass the wow-factor even then for this 6-year-old. 
But, I do remember the excitement when my sister was bitten by a horse as she went round and round in the horse corral.  The horses were all old, a bit on the glue-side of life, and shouldn’t really have been interested in eating children.  The poor horse likely had cataracts, mistaking her bony leg for just the stalk of a corn plant.  I bet that he was surprised too and would have been heard crying in disappointment if not for the racket my sister made.  Diane made so much noise that my mother almost assaulted the guy operating the ride to stop the horses and to rescue her.  Diane had a “little” mark on her leg (not more than a tooth or two punctured her skin and then without the loss of any meat) and I don’t think this episode interfered with her subsequent equestrian career, which she chose not to pursue after all. 
Why tell you this childhood remembrance?  Not because I want to let you in on my sadistic thinking. The lesson to be learned from this digression is that circuses can be scary places which sometimes hurt spectators. 
In healthcare, professional consultants come to town on a weekly, daily, and hourly basis.  They too bring acts and animals along for us to see and enjoy.  Nothing is free, so we pay a lot of money for tickets to see these performances.  Often the consultant on parade is just of passing interest and fame.  This isn’t to say that all acts are short-lived as we know all too well with HMOs, Medicare, and DRGs.  But, do you really remember the sub-professional capitation financial arrangements (made in California) or the Joint Venture fever of earlier years to “align” physician and hospital interests (read: get the doctors to feed my beds)?  Now we are again looking forward to the newest show, the Hospital-owned Medical Group Model.  I think this act last came through town in the 1990s, causing a few hospitals lots of pain.  Sometimes the most captivating acts involve a little pain (remember my story about the horse that ate Diane’s leg?)
You will be heartened to hear that consultants are alive and well in the rest of the world.  Don’t get me wrong, consultants are very smart and talented.  Why, one or two of my best friends are consultants (I too did a little side-consulting over the years ;-)).  But, consultants operate in a world that is driven by the invective, “sell.”  To this end, the whole world is a possible buyer of consulting services when North American consultants (ringmasters without whips or chains) are on parade.  Why, North Americans represent the Greatest Practices on Earth! 
I now pay attention to the international healthcare market by reading more than just The Economist’s coverage of health, by talking with providers and reading information distributed here in the Middle East.  My caution about hiring consultants comes from knowing that native talent exists in country today at a fair price.  The real challenge is to identify the local and native talent, put them in the big top tent with really bright lights to perform.  I will watch and learn too.
Be careful and look out for the painful bite you may find in the circus tent.


  1. May I suggest a Cirque du Soleil sans animals sort of performer? Even local clowns should work independently, be self-reliant and perform well without having to oppress other creatures.

  2. Nice new look. Beige is more suitable color choice yes? Healthcare turning upside down back in the states. Consulting is the best way to work. Hot on your old trails. Finding your footprints everywhere!