Monkeying With Medical Scheduling

An experimental brain implant the size of an M&M has allowed a monkey to control a computer cursor by thought alone, Brown University researchers announced Wednesday -- Los Angeles Times

Wouldn’t you know it -- you finally get some sort of control over your mouse, knowing when to right click and how to scroll, then learn a monkey can do by thought alone what it took you six months to master and you still screw up.

We know what you’re thinking -- this is another of the Times’ staff writer’s little pranks to liven up a slow news day. There is no such university called "Brown," right? Why not Harvard, or Yale, or Dartmouth? We could believe maybe Berkeley where the kids run their own classes, according to reports, and implanting M&Ms in monkey brains would be on a par with panty raids and swallowing goldfish, but Brown?

Well, pay attention -- Providence, R.I., is the home of Brown University. It was founded in 1764, currently boasts about 8,000 students who lay out $34,750 a year in tuition, and if Brown University says it has a monkey that controls computer cursors just by thinking about it, you have to stop that snickering and go along.

Senior researcher John Donoghue, Brown neuroscientist, explains: "We have substituted thought control for hand control." Obviously, there is a lot more to this, most of it involving tiny electrodes and neurons and the motor cortex section of the brain that is usually concerned with the necessary skills to separate Oreo cookies to get at the white stuff.

What’s important here to ordinary people like yourself who have trouble understanding gravity, electricity and why each of the cast members of "Friends" should be paid $1 million per episode is this: If a monkey can be trained to operate a computer to the point of winning solitaire 3 out of 5 times, why can’t medical personnel be trained to schedule appointments so that patients with official handwritten cards stating that they have an appointment at exactly 10:15 a.m. can actually be seen before 5:30 p.m.? How about THAT, Brown University?

In an effort to expedite some action on this vexing problem, we have been doing some research ourselves only to arrive at this pessimistic conclusion: More and more people are being seen by fewer and fewer health care providers until in the very near future, everybody will be seen by nobody. There is plenty of blame to go around, starting with the doctor.

* Doctor A’s ego is fed by the belief that he is indispensable, the proof lying in the fact that his waiting room is overflowing. More patients = more billing = more money. His instructions to the front desk: Book ’em all, turn nobody away, refer nobody out, we can handle it.

* Doctor B is a wuss who can’t say "no" and has no concept of his limitations. He is the Dr. Schweitzer of his town and will die at age 53 while contributing largely to the diminished life expectancy of anybody who works for him.

Both Doctor A and Doctor B have a poorly developed sense of time. If asked what time was represented by "the little hand is on 3 and the big hand is on 11," they would be hard put for an answer. "Lunch time?" would be a typical response.

* Nurse A is in charge of scheduling. She routinely tells patients A, B, C and D to come in at 10, knowing the doctor sometimes doesn’t return from rounds until 2, if then. "Have a magazine," she directs. "Doctor is running a little late." Not to put too fine a point on it, but "a little late" frequently means upwards of three days behind. There is a clause in the doctor’s MD diploma that states, "Never, ever phone a patient and say, ‘Stay home for God’s sake, we’re four hours behind schedule right now!’"

* The state medical board would perhaps consider suspending the license of a doctor who had signed 40 or more of his patients’ death certificates in the past 10 days but would instantly revoke the ticket of any doctor caught actually apologizing for keeping a patient waiting in a drafty paper gown on a wax paper-covered table for as little as two hours.

* In way too many doctors’ offices, not a single soul has any idea of how much time any given procedure will take, although they have been doing this for decades. "Five minutes" is their guess. If they have five treatment rooms with a patient in each one aging rapidly, the estimate is still five minutes. In medical math, this amounts to 60 patients per hour. In the waiting room the sound of "Baaaa, baaaa" is heard.

* Staff members, some of whom have been known to feel some degree of remorse for the gridlock, have been instructed to avoid eye contact with restive patients. If this should happen inadvertently, the guilty staffer is to announce in a loud voice that "Doctor has been delayed by an emergency and will be here shortly." This is calculated to make the ruffled patient ashamed to have put his ruptured spleen and broken pelvis on a higher priority than some poor devil’s emergency.

Conclusion: When Brown University is through with the three monkeys they now have under training, they should immediately implement a crash course for them in medical scheduling. The need is great, the opportunities endless and if the primates can be taught to offer any kind of a caring apology, even if it’s a banana, millions of frustrated patients will be forever grateful.