Random Thoughts from a Restless Mind

I have been pretty generous in sharing my thoughts about some of the ills of our American Healthcare system, especially with regard to the barriers erected between physicians and patients. I find the various proposals now before our legislative bodies in Washington to be rather curious, even offensive. Since when does the United States of America adopt wholesale an economic solution from another country? Especially another country that is in some way otherwise riding the considerable coattails of the U.S. economy?

The “baby with the bathwater” approach in the halls of our Capitol and the editorial offices of our leading media outlets (WSJ excepted) is about as wrong-headed as you can get.  What we need is an AMERICAN solution to the challenges that we presently face with the economics of healthcare in the U.S., using our present system as the foundation.

Not surprisingly, I have some thoughts!

1) Malpractice tort reform. See my thoughts in “Tort Reform = Healthcare Reform”. Effective reform will dramatically reduce the scourge of defensive medicine with its attendant costs and risks to patients. Defensive medicine represents 15-25% of all medical costs in the U.S. That’s 15-25% of $2.5 Trillion. Do the math. While we’re at it, how is it good for the country to allow the tort bar to advertise for cases? Rake the muck in the hopes of unearthing errors or imagined?

2) Tax Reform #1: Remove the tax deduction for employer-offered health insurance. Provide a 100% TAX CREDIT to the lowest 60% of wage earners for the purchase of health insurance. Provide a progressive TAX DEDUCTION for the upper 40% of wage earners.

Tax Reform #2: Remove the tax deduction for advertising as a business expense for Hospitals. If we are concerned about unnecessary increased utilization of medical resources why are we allowing advertising by hospitals? For that matter, remove the tax-exempt status of any hospital or  provider that advertises. How is it appropriate to allow a hospital system to advertise to increase revenue, deduct that advertising as an expense, and still be not-for-profit? If it looks like a for-profit business, acts like a for-profit business, and sounds like a for-profit business, tax it like a for-profit business.

3) Insurance Reform #1: Reverse all of the for-profit conversions of previously not-for-profit health insurance companies. Who was the genius who thought THIS was a good idea? I don’t remember insurance premium increase that were quite so massive when all of the Blue Cross/Blue Shield plans were not-for-profit, do you? And while there were $Million execs in the non-profits I don’t recall any $10, $20, or $100 Million execs. Removing the need to answer to the stock market will create companies that will compete quite nicely with the for-profit companies without the horror of a government run system. Let the equivalent of NGO’s compete with the United Healthcares of the world.

Insurance Reform #2: Remove state-level coverage mandates and create a minimum federal set of mandates for comprehensive insurance policies. A REAL minimum. REAL medically necessary items. No Viagra or artificial  insemination coverage. Allow cross-state competition for the business. Real competition always drives prices lower.

Insurance Reform #3: Allow insurance companies (Medicare and Medicaid included) to discriminate IN FAVOR OF people who make healthy lifestyle choices (eg. no nicotine, no DUI, etc.). We are all so afraid of the stick that we refuse to allow any use of the Carrot.

4) Freedom of Speech/Restraint of Trade Reform #1: Abolish, once again, direct-to-consumer pharmaceutical advertising. There was a quantum leap in the utilization of all sorts of medications immediately following the 1997 rulings that allowed DTC pharmaceutical marketing. If it is so obvious that our ever-increasing levels of spending on medical care is a threat to the very existence of our fair Union, then DTC drug marketing is a version of yelling “FIRE” in a crowded theater.

Freedom of Speech/Restraint of Trade Reform #2: Begin a return to the professionalism of yesterday by prohibiting all forms of advertising by, or for, physicians. The AMA gets a lot of criticism, most of it well-deserved in my opinion, but the court and FTC rulings that prohibited the AMA from censoring physicians who advertised was a seminal event in the de-professionalism of doctoring and medicine. Doctors and other medical advertising was, is, and always will be wrong. While we’re at it, do the same thing for the rest of the lawyers and the practice of law.

5) Public Health. Finally, and most importantly, go to the true root of whatever “Crisis” we may have here in the United States, be it a “Healthcare Crisis” or a “Healthcare Finance Crisis” or what have you. We as a people are not healthy; certainly not as healthy as we ought to be. We are not healthy because of some wrong-headed previous Public Health decisions (simple-carbohydrate based diets, abolition of school phys-ed programs, tort-fearing closures of playgrounds, etc.). We are not healthy because our ability to treat the diseases that result  from poor lifestyle choices (cigarette smoking, alcohol abuse, preventable accidents, etc.) is SO GOOD that we are able to keep more and  more unhealthy people alive longer and longer, paying ever more to do so along the way.

This is where true leadership can make a difference. Remember JFK and the President’s Council on Fitness? I do. 8 pull-ups in the fifth grade for me. Polio, measles, smallpox and whooping cough were once the leading killers of children in the U.S. but are now historical footnotes due to Public Health initiatives. (A pox on all the cretins advocating against childhood immunization).

We lead the world in per capita alcohol related accidents and deaths, losing young lives by the thousands each year. We have ever more increasing numbers of truly obese citizens who go on to suffer the diseases caused by that obesity, and we pay ever more for their diabetes, hypertension, strokes and heart attacks. These lifestyle choices are root causes for our increased expenditures on Healthcare, much more so than all of the targets of Beltway demagoguery like insurance company expense ratios and pharmaceutical company profit margins. A solution to this issue, more than all of numbers 1 through 4 combined or any other proposal yet floated, is the true crux of the solution to any “Crisis” we may be facing. Everything else is only there to buy time. Time to get healthy.

Pick a number; choose an age. 40. 50. 60. Anyone under that age gets “Well-care” or “Get Healthy Care” starting right now. Over that age they can have “sick care” only if they wish, but under that age if you try to be healthy you get rewarded.

There are no votes to be had in making Americans healthier. Nothing but hard work on every side of the equation. Who will stand up and do the hard work? Who will lead?

Who will have the guts to not only say that the Emperor is naked,  but also drunk and fat and puffing away our economy.

Sunday musings (courting controversy)…

1) Volume. If you undertrain you may not finish; if you overtrain you may not start.

Lotta meat on that bone, especially around Games season.

2) Enabler. One who provides either implicit or explicit support of dysfunctional or harmful behavior.

I am an American physician, a specialist. Universally reviled, and nearly universally acknowledged as being at the root cause of what people regularly call our “dysfunctional healthcare system.” Funny thing, though, but my specialty includes providing ongoing care to patients with chronic eye diseases. I actually bridge the divide between specialty care (highly complex, single–organ surgery) and chronic primary care. Every day in my office I see patients with type II diabetes and other diseases that are at the very least highly influenced by lifestyle decisions.

We do not really have a healthcare system in United States, but rather a sick–care system. We actually do a pretty good job in pediatrics with a well thought out, well–established system of well–baby and well–care visits for the vast majority of children in America. Somewhere after our children leave their pediatricians in their teens the whole concept of well–care seems to disappear. No longer guided by the doctors of their youth, Americans are left to their own to make decisions about where their priorities will lie. This is certainly true of health and wellness.

There is an article on CNN.com today written by a very well spoken, highly intelligent and intuitive primary care physician from New England in which he cites a couple of examples of patients who got sicker when they decided they could not afford care for their illnesses. His approach disappoints me greatly; the appeal to the emotional is just one more way that our American sick–care system is the great enabler of our Nation’s un-well.

Think about it. We actually have the very best sick–care system on the planet. We manage to keep incredibly sickly and unwell Americans alive, and to some degree functional, in SPITE of horrific and horrible health–related decisions on the part of these individuals. Cardiac bypass surgeries and coronary artery stents. Evermore complex oral diabetic medications layered one upon the other. Heroic, simply brilliant surgical interventions to replace the joints of people who managed to double and triple the “load” they were meant to carry.

Our “health care system” not only enables our population to abuse their health and their fitness by rescuing them from their excesses, but in its present and proposed future forms it also insulates them from the responsibility of being healthy. There are certainly a minority of people who cannot afford sick care, but that number is buried by the number of people who choose to not be able to afford either health-maintenance or sick care. You only need to spend one day in a doctor’s office watching people finish a conversation on their iPhone ($499 + $100/month) about a game they watched on ESPN last night ($80/month for cable) before heading to the brewpub (smothered fries!), as they walk out to their new car ($500/month) to retrieve their iPad ($699 + $60/month) and catch a quick smoke ($5/pack, 1 pack/day), just before they complain to their physician about how hard it is to pay for their diabetes medicine.

3) DWB. Driving While Black. No matter what the story eventually turns out to be, there is very little that is good that is likely to come out of the Trayvon Martin debacle. Not for the Martin family, not for that neighborhood watch guy, and probably not for society as a whole, at least for quite a while. Why? For the simple reason that it is now 2012, we’re still having this conversation, and nobody has demanded change.

Let’s go back a bit, shall we? How about a trip to 1979 and suburban Rhode Island. I’m driving the family beater, my close friend in the passenger seat waves at a police car as we drive by on our way to the mall. My close friend, STILL my close friend, happens to be a very large Black man. You guessed it–flashing lights followed by “license and registration (no please).” Why? A version of Driving While Black.

“Come on, bingo. That’s ancient history. Things are different now.” Well, let’s move forward a bit. Dinner chez bingo sometime around the year 2000. My good friend the Rev. Mel and his beautiful wife are joining us at our house for dinner. Mel, a black Baptist minister, drives a bullet-proof Mercedes sedan. Never more than 5 mph over the speed limit. The Woodards were late for dinner. When I teased him about it Mel just shrugged his shoulders and said “DWB.” Even impeccably dressed for a dinner out, Mel was still a Black American man.

Now? I young black man in a hoodie returns from an errand, surely guilty of something until proven innocent. A non-black man approaches the youth, surely someone to be feared until proven otherwise. The fault, my friends, lies on BOTH sides of the conversation. At this late date in history it no longer matters what came first, you know? One side of the conversation needs to openly acknowledge that the vast majority of the other side does NOT participate in violent criminal activity. This part of the community needs to openly acknowledge this and aggressively teach that lesson to people of all ages. The other side of the conversation needs to openly knowledge that their ARE small parts of their community who DO engage in violent crime and to go about the hard work of isolating them as the outliers that they are and shunning them as a pox on BOTH communities.

We need to be done with the blame game. Indeed, indulging in finger-pointing at this late historical stage is also a type of enabling. By taking the easy way out, blaming this one for not fighting harder against unsupportable prejudice or pointing the finger at that one for some weak justification for criminal behavior is quite simply enabling the prejudiced and the predators to continue their pathologic behavior patterns.

NONE of us could have influenced the tragic outcome of that encounter In a random Florida neighborhood. ALL of us…Black, White, and other…have the duty and the responsibility and the ability to do the hard work necessary to prevent what STARTED it.

Start now.

I’ll see you next week…

Comment #16 – Posted by: bingo at March 25, 2012 8:38 AM

Crossfit. Constantly varied functional movements performed at high intensity. At 52 years of age I am nearly the athlete I was in my twenties. How can that be, you might ask? Well, while I am not truly as athletic as I once was, I believe that I am more FIT than I ever have been. This is allowing me to participate in athletic and other physical endeavors that I really have no business thinking about at my age. What kind of athlete might I have been if I trained in my teens and twenties the way I train in my forties?

All sports came easily to me in my youth. Blessed with the genetic gifts of eye-hand coordination, speed, and quickness there was literally no sport that I tried in which I didn’t excel. Couple this with the fact that I was a very early grower (I was the center on my Jr. High JV hoops team) and I was the classic local sports prodigy for that era. In addition to pulling me out of the deep end of the athletic gene pool my parents also provided a home environment that was bathed in competition. Heck, blood might be drawn when my siblings and I tried to make the first mark in a new jar of peanut butter! I was far from special in my family; all four White kids were All-State in something, and my brother might still be the best natural athlete I’ve ever met.

The first time I “peaked” as an athlete was freshman year in High School. I didn’t know it at the time, of course, but I would never be a better High School athlete than I was that year. I had stopped growing (I was now the point guard on the High School JV hoops team), and I continued to depend solely on my natural ability. I was still skilled, fast, and quick, but I was not terribly FIT. Under-strong. Not a ton of stamina. Typical teen diet. Add in a couple of injuries and a family move and I really didn’t return to that freshman year peak until my senior year.

My next peak as an athlete came in my sophomore year in college. As a freshman Division III tailback I did well enough, but the head coach was rather underwhelmed by my size and suggested a switch to defense. Stung, I set about proving him wrong (credit that family competitive gene) and got stronger, bigger, and tried to get faster (oops…better not get THAT much bigger). For the only time in my athletic career I trained to be a better athlete, a better football player. It helped immensely that my position coach, Dick Farley, turned out to be the best coach I ever had, and that he cared more about results than size. I started a bunch of games as a sophomore and really played rather well.

I then reverted to my tried and true, relying on whatever remained of those original genetic gifts from my parents. I never got better. Not one little bit. Given the opportunity to play tons of football over the next two years, to receive the benefit of magnificent coaching and possibly become a player to remember, I coasted. In the end I was nothing but a middle of the Bell Curve DIII cornerback, an average  Division III athlete. I wasn’t fit enough to do the work necessary to continue to get better and along the way I let both myself (and my teammates) and Coach Farley down.

If only I knew then what I know now. If only I had then what I have now. Bored and lonely in the gym, watching the ever outward creep of my waistline and the ever upward creep of my cholesterol, I stumbled upon Crossfit in the periodical Men’s Journal in December 2005. As a doctor who made it through Williams College, med school, and a residency I had long since learned that I wasn’t really THAT gifted. Hard work was now an intellectual and life habit, but until I  discovered Crossfit I had yet to do the same thing as an athlete. Whoa! This stuff turns out to be pretty powerful medicine!

“Practice and train the major lifts: deadlift, clean, squat, presses. Master the basics of gymnastics: pull-ups, dips, push-ups, sit-ups. Bike, run, swim, and row hard and fast. Mix these elements in as many combinations as creativety will allow. Routine is the enemy. Keep workouts SHORT AND INTENSE. Keep food intake to levels that will support exercise but not body fat.”–Greg Glassman.

On January 1st, 2006 I began the Zone diet and I did my first Crossfit workout, “Angie”. Crossfitters name their benchmark workouts after women. You know…like hurricanes. 100 pull-ups, 100 sit-ups, 100 push-ups, and 100 air squats. For time. For, like, as fast as you can. Seriously. It took me 45 minutes to complete and it took me 45 minutes to get up off the floor. All 100 of the pull-ups were assisted and 80 of the push-ups were from my knees (word of warning: don’t call ‘em girlie push-ups. Most Crossfit women are scary fit and NEVER do push-ups from their knees).

I was hooked! My fitness went through the roof. My waist size shrank. My cholesterol plummeted. Three days on and one day off for 6 1/2 years and I am as fit as the day I graduated from med school at age 26. World class fitness based on workouts that typically last 20 minutes or less utilizing functional movements performed at high intensity. Competition? Yup. Me vs. me. Every day is a competition in which the opponent is yesterday’s version of Darrell, and victory is achieved if tomorrow’s version is just a little bit better than today’s.

So why now? Why at age 46? I confess that I just don’t know. I was certainly ready for Crossfit at 46, but I would probably have been ready for it at 36, too. I’m just very happy to have found it at all, frankly. Very happy to be more physically fit today than I was yesterday, with the hope that I will be able to continue to say that for years to come. Coach Glassman thinks most athletes can hope for 10 full years of improvement no matter when they start. Man, wouldn’t it be great if he was right and I still had a few years of getting better to look forward to!

Yet I do wonder, every now and again. I can’t help but wonder, what kind of athlete might I have been if I had Crossfit as a young man? If I could have been ready for Crossfit as a young athlete. When I had Dick Farley as a coach.

How many more peaks might I have reached?

A week ago I ended my weekly “musings” with a thought about CrossFit and character. “CrossFit doesn’t so much create character as expose it.” I think the implication of this during a WOD (workout of the day) is quite obvious; we see glimpses of an individual’s true character during and after a WOD. Did they will themselves to that dark place where we find the magic of the program? Were they honest, counting every rep and striving for the virtuosity inherent in a perfect movement? Was their post-WOD analysis of the performance free of excuses and directed toward yet more improvement?

CrossFit tends to identify those character traits that lead to more of better, but to seek more of better requires that at least some of that character be in there to start. Hence my contention that CrossFit is more of an identifier, and perhaps magnifier, of character that is already on board.

I’ve found time and again that CrossFit and CrossFitters tend to benefit from something called “transference”, the extension of a training benefit in one domain into another wholly different, unrelated domain. For example, I handle the stress inherent in my day job a full order of magnitude better now, despite the fact that my advancing age should produce just the opposite. I believe that this is because I have trained my ENTIRE stress response in the WOD, not just my physical. By purposefully placing myself under the very significant stress of high intensity exercise I have trained my neuro-endocrine system to respond in a less dramatic fashion to ever greater levels of stress.

As an extension of this the CrossFit community has almost always been a “live and let live” place, something that stems from a broad-based sharing of this particular kind of physical experience. There’s an assumption of goodwill among and between CrossFitters, those who’ve met and those yet to meet. As we’ve grown as a community so, too, has grown the extent to which we encompass the vastness of the differences that can exist between human beings. When CF was young you would find more of these vast differences co-existing under one roof; there were simply fewer roofs back then, eh? CrossFitting in common was enough to overcome almost all differences. We were all a little different, only together. If you wanted to CrossFit or be part of the CrossFit community there just wasn’t much of a choice.

Now? The neighborhood has grown. You likely have many options. Multiple Affiliates in most cities to choose from. You can do CrossFit among folks who share much more in common than just the WOD, a little island of CrossFitting homogeneity. Is this such a bad thing? Of course not, at least not on the surface. People like to hang out with kindred spirits. Where this becomes not such a good thing is when the OTHER, non-CrossFit similarities in one group become the focus, when it is NOT the CrossFit that defines what is or isn’t held in common. This saddens me.

Think about this, won’t you? As CrossFit grows there is simply no reason why this wonderful part of the whole experience, ignoring or forgiving our differences while focusing on the wonderful thing we share, must be lost to the growth. At least for all of us out here in the great “outdoors”. So excited about something great about your CrossFit? Awesome! Sing it loud, but there’s no reason to do so while knocking someone or something else. Someone else doing something really great? Cool! Tell everyone you know, don’t try to bury it.

There will be times when something very real happens. Sad, but true. In these instances CrossFit, too, can reveal character. When that happens, whether you might have tossed the first grenade or simply returned fire, DO be the one to stop. “Less said, sooner mended” as my lovely Beth likes to say. It’s way harder and really uncomfortable to do that, be one who says ‘enough’, but you can do it. You do really hard stuff that makes you uncomfortable all the time, on purpose. So do the other folks.

You do CrossFit.

Skyvision centers is a hybrid organization that brings together multiple, disparate skill sets in a medical environment. If you ask any of the staff or doctors who we are and what we do you will hear something along the lines of “we’re a customer service business; our product just happens to be eye care.” The founding principle for Skyvision was the creation of a truly patient-centered experience achieved by borrowing liberally from such customer service stalwarts as Nordstroms and the Canyon Ranch Spa organization. These practices were then layered on top of a flow process that was adopted from the Toyota manufacturing system in order to allow the doctors and staff to provide medical care that exceeded all industry standards for outcomes, safety and efficiency.

It became clear very early in the development of Skyvision that a traditional management structure would be counter-productive. Most small businesses, and essentially all medical businesses, are run using a steep pyramid set-up: doctor at the top, office manager next, and all kinds of middle management on top of the folks doing the real work of caring for patients. Command and control was exactly the wrong strategy for us. We adopted the ultimate flat organizational structure, the POND.

The Pond Theory of Management is best viewed from overhead. Unlike the pyramid of the traditional management flow chart, the Pond Structure is nearly invisible when you look from the side. Staff members “float” on the pond like overlapping lily pads. Tasks are determined initially by job description. Responsibility for seeing that larger projects are accomplished is determined by “mutual affirmation” in the overlapping individuals, and those who affirm a leader take on the responsibility of helping that task leader succeed.

With the appropriate systems in place and so much of what we think of as traditional staff management happening on something that looks like “cruise control”, what is the role of the “Boss” in a flat organization? Rising just above the lily pad-covered surface of the pond are the very few “flowers”, the leaders of the organization. If the “Tribe of Adults” is managing its own intra-staff personal relationships and taking responsibility for outcomes, what does the Boss do?

The common misperception of management in a flat organization (and in groups practicing TQM/CGI) is that there is no longer a leader or “Boss” role at all. This, of course, could not be further from the truth. The primary role of leadership in a flat organization is to make broad policy decisions and set major goals for the organization as a whole. The first of these is to choose to have a flat organizational structure! It is the few leaders who are charged with setting the general course of the business, from choosing the products or services to be offered, to determining the variables that will be measured to keep the organization on track.

Once the organization is up and going it’s important to identify the metrics necessary to maintain a tight focus on the goals that have been chosen. Monitoring these metrics and reacting to them is the responsibility of the “Boss”. From just above the Pond an effective leader is able to offer broad guidance without being involved in the minutiae of the day-to-day machinations of the business by reacting to these metrics. This also frees up the Boss’ time for critical planning, meeting with significant customers, and other larger picture tasks that will help the business grow and prosper.

It seems as if the flat organizational structure is designed to inoculate the Boss from any real staff management, doesn’t it? In reality, the only thing that the Boss might miss out on is any of the fun aspects of day-to-day interaction with employees. For better or for worse while the Boss may not do the hiring it is the Boss, and only the Boss, who must do the firing. At the end of the day, a business that chooses a flat organizational structure is not immune to any of the factors that make an individual employee an unsuitable member of the team. Remember, there are no managers, only a Boss, and no one else available to perform this (hopefully rare) task.

The role of the Boss in a Flat Organization is at once bigger and smaller than in a traditional hierarchical structure. Smaller in that the number of management tasks he is asked to perform is radically reduced. Bigger since the remaining tasks are more global and reach into every aspect of the business. Certain types of individuals are more geared to fulfilling this role (it helps to be a little more laid back and patient), and certain abilities are more helpful (delegation, data analysis, “blue-sky” planning). Indeed, the more of these characteristics one has in a leader, the fewer leaders you need!

The better the Boss, the flatter the organization.

How am I going to approach the 2012 CrossFit Open? I’m a realist. I will not qualify for the CrossFit Games. I’m in the Masters age 50-54 division and even here I am simply too small and weak as a kitten (at least in comparison with my competitors). We will be required to use the same loads and do the same exact WOD’s as the 20-something firebreathers. Last year the weights were simply too much form me; I don’t see ’em getting any lighter this year.

So what will I do? Well, I’m certainly going to make the effort to get a legit score on each workout. Like the 2011 Open it’s exciting to be a part of the conversation. I have every expectation that the loads will be on the very edge of my abilities, but so what? It’ll be a worthy test.

However, I did learn a very important lesson last year. The Open totally messed up my training. Wrecked it in fact. Five weeks of inconsistency. I altered my WOD’s early in each week, and I rushed to CrossFit Cleveland every Thursday to get the Open WOD done at a registered Affiliate. Remember the mantra “form then consistency then intensity”? Consistency got the shaft.

This year my approach will be a bit different. My CrossFit program is designed to fit around my life, specifically my OR schedule. Some of those Open workouts were so beyond my reasonable ability that they were essentially worthless as training, and that made me lose one workout each week. One of four. My Open experience this year will fit my schedule and my training program. I train for tomorrow…for life. I’m pumped for the Open, excited to be part of the conversation, but my competition still needs to be “you vs. you.” After I give my all to the Open WOD as Rx’d my plan is to do a scaled version adjusted so that I get the same TRAINING  stimulus from the WOD as the better CrossFitters are getting.

Will it work? Heck, I dunno. Might be the best of both worlds, but then again I might crash and burn, too. I like the idea that I’ll be testing myself not only against the rest of the CrossFit community but also against myself. Last year I allowed the Games to occupy me.

This year I occupy the CrossFit Games!

The first workout for the Open, the gateway to the CrossFit Games, will be announced Wednesday, February 22. You’re in, right? Registered and ready for the first WOD? Maybe you didn’t register but you’re gonna do the workouts anyway. Great! What are your goals? What’s your strategy? You thought about this, right? Re-visited your CrossFit goals, your life goals, and how the Open fits in? Right?

Like I told you last week, you are I aren’t going to the Games. Not gonna happen. Sorry to be the one to break it to you. Only ~1000 of us will go to Regionals as individuals, and maybe another ~2000 or so as team members. Probably not you and me, though. We’re doing the Open for all the reasons I mentioned last week. We’re part of a community and this is how we take part. We’re fortunate enough to be able to do pretty much exactly what the best CrossFitters will do, just like we’re playing Pebble Beach after Phil and Tiger. We’re gonna do this because we own it. We’re CrossFitters; registered or not we do the Open.

But how? Think about this a bit. This is important. No going on cruise control here. What are we going to do?

The Open WOD’s will arrive during our training. We can simply apply them as such, another training tool, and just do them in the course of the week as another WOD in our program whether we send in our score or not. If memory serves, the Open WOD shows up as one of the Main Page CrossFit.com WOD’s as part of the flagship’s programming. Perfectly legit way for us to be a part of this gig. We can also work them into our training as a test, use them as a little measuring stick of our own personal fitness. You know, my whole “you vs. you” thing. Another perfectly reasonable application.

Or we can ramp it up a bit and compete. After all, The Open is a part of the CrossFit Games season, and this is the Sport of Fitness. There will doubtless be scads of local competitions using these WOD’s, some within individual Affiliates, some just among friends. Any place there’s a clock or a scoreboard (or both) and more than one athlete you’ve got a contest. We don’t need $250,000 on the line. Bragging rights, a new tee-shirt, last one to buy a round at the next Affiliate gathering? The prize isn’t the prize. Why the heck not?

Maybe you’ve been aiming for this for months, ramping up your training, tightening your nutrition, clearing your schedule. For you this is serious. Each week is about planning your attempt, the timing, pre-WOD rest, maybe a dry run on Thursday and a redline effort on Saturday. Maybe you’ve got a real chance and maybe not. Who cares? The point is that YOU care! In your mind you are not like me and most of us, and you’ve been just itching for these five weeks since, well, LAST year’s Open.

The point is simple: this is your CrossFit Open. Think it out before you start the journey. Drive the Open, don’t let it drive you. Pop the clutch. Grab the wheel. Decide what it means to you,where and how you’re traveling. Three more days to set your course.

Occupy the CrossFit Games!

One of the strongest statements yet made in support of the private practice of medicine was made this morning at 8:00 AM, EST. I went to work.

What’s the big deal? Of course you went to work. You’ve got a job and today is a work day. Ah, Grasshopper, there’s the rub. I am a doctor in private practice. I don’t have a job, I own a job. I don’t report to any centralized HR department; there’s no single supervisor looking over my shoulder. Nope, I’m a practicing physician in a private practice specializing in eye care, and this morning there are some 60 patients who’ve scheduled appointments and a staff of 14 on their way in to the office, all of whom are depending on me going in. So even though I feel like a damp campfire long past its useful life, I came to work.

If all I had was a job I’d a stayed in bed.

The dirty little secret of private practice medicine is that market-based economics works on a micro basis. There’s payroll to meet and rent to pay. The mere perception that your patients will leave your practice if you don’t go to work drives the private practitioner to work even when she feels lousy. Even more than that, the absence of a corporate barrier between doctor and patient makes the private practice doc think twice before he takes that sick day, because each one of those patients belongs to him, and vice versa. The unfiltered connection is so personal that the private practice doc thinks about what Mrs. Pistolaclionne (bonus points if you name the movie) will say if he calls off sick.

The dirty little secret in large, corporate medical practices is that market-based economics work there, too. All that talk about how your “World Class Clinic” doctor isn’t paid by how much work he does? Nonsense. In fact, the amount of money generated by any individual doctor is even MORE closely monitored and includes stuff like how many tests and procedures get done on her patients even if she isn’t doing the work herself. That doc’s compensation is absolutely driven by how much revenue she is responsible for bringing into the institution.

It’s just that the corporate Doc doesn’t own a job, he simply has a job. He has no direct responsibility for the staff surrounding him or the bricks and mortar over his head. His compensation is driven by his corporate performance, and that compensation includes time off for vacation and for sickness. Leaving time on the table is the same as leaving money there. There’s no bonus for loyalty to the institution. Points aren’t accrued for attendance. Frankly there are no real points to be won for extraordinary customer satisfaction, only demerits for egregious behavior. Unused time off, like extending your hours or taking patient calls when it’s not your turn, is simply donating your services and talents to your primary constituent, your boss the institution.

We should all be very cautious about the trend toward fewer private practice doctors and more docs employed by ever-larger institutions. Continuity of care is more than simply an always available electronic chart, it’s also a relationship forged over time between two real, live people with skin in the game. The next time you see your private practice doc and she’s a little sniffly and hoarse, remember to give her a little pat on the back and a ‘thank you’. After all, she owns this job and could have stayed home today, but she knew you had an appointment.

She knows who she works for!

Fly an airplane. Take Dad’s car on a date. Finish your residency and perform your core surgery without a professor over your shoulder. The first solo is a milestone event, and many such events become life’s touchstones to which we return time and again. My first solo attempt to log on and clear out my “Basket” on EPIC, the EMR that I am mandated to use in order to continue to operate at a surgery center where I’ve been the primary ophthalmologist for >15 years? Meh, not so much.

At 0 Dark 30 I was doing glaucoma lasers, and I finished well before I was due in the office. Perfect time to log onto a dedicated terminal, take a look at the items demanding my attention, and get on with the real work of eyecare. Full disclosure: I called the IT guy with whom I’d bonded a  couple of weeks ago to see what I should do with the pharmacy boondoggle and received permission to blow off all of those entries. Whew! Home free. I sat down and went through the log-in process, just like my new best friend had shown me. No love. 0 for 15. Unable to log in.

BZZZZTTT. Sorry. Johnny, tell Dr. White about our lovely parting gifts for losing contestants.

Might turn out to be more like expected after all.

The CrossFit Games season is upon us. The Open begins in 10 days. Do you care? Should you care? Why?

You, me, we are the 99% of CrossFit. Seriously, the chances that you or I will make it to the Regionals is pretty similar to the proverbial snowball thrown across the River Styx. It ain’t gonna happen. Is that the kicker?

The Open is going to be too heavy and too long for you and me. It sure as heck was last year. I don’t expect that we will see too much more in the way of load this year (I think Tony Budding and Dave Castro did a remarkable job making it inclusive last year), but I also don’t see it being any lighter, either. Will that be your tipping point?

It’s impossible to plan for the Open WOD’s. They come right in the middle of the week, and if you push your Open attempt back to the weekend you have to decide how you will prepare once you know what’s coming. It wreaks havoc with your training and your schedule. What’s gonna give?

Do you care? Yes, you do. Why? Because where else can you play Pebble Beach, the same track as the big boys and girls, for $20? The Open is your chance to take a few laps at Indianapolis Speedway or that fancy-dancy roadway in Germany whose name no one can pronounce. Old or young, big or small, you get to dig in at home plate and take your hacks at Fenway Park, field a punt at Candlestick, line up your PK at Wembley.

You are part of a much larger whole, whether you are a member of an Affiliate gym or a solo CrossFitter in a Globo. This is the time of year when everyone still comes to a central cyber-gym, congregates around the CrossFit table, and dines on our particular fitness cuisine. Together.

You…me…we are the 99% of CrossFit, and the Open is ours. You do care. You’re damn right you’re in. Register. Post.

Occupy the CrossFit Games.