Gem of Thailand

Towards Mt. Shishapangma - photo by JoAnn Sturman

Scott Sturman

fliesinyoureyes.com

Atul Gawande has worked for the Presidential campaigns of Gary Hart, Al Gore, and Bill Clinton and began writing articles for the New Yorker Magazine as a surgical resident.  He has a way of presenting clinical medical issues in a manner which is entertaining and easy to read.  Of late he has eschewed the medical side of medicine and devoted his skills to convincing the public about the benefits of national health care.  This month in the New Yorker Magazine he suggests the U.S. health care system should be run more like the Cheese Cake Factory.  The clever comparison made its way to NPR, which immediately aired an interview with the author, who is not known as a champion of private practice medicine.  For Dr. Gawande to recommend a casual dining company as a model for the slightly more complex health industry, he must perceive the restaurant’s standardization, copious menu, tasty beverages, and inviting atmosphere as the epitome of the culinary experience.  Although the utter sameness and predictability of the Cheese Cake Factory make it a suitable metaphor for national health care, it is known best for its dessert menu: the portion of the meal which Americans should be most wary and avoid most often. 

Standardization is key to the casual dinning industry and socialized medicine.  As an example, the author cites a protocol developed at Brigham and Women’s Hospital in Boston which has led to a reduction in hospitalization days for patients undergoing total joint operations at that institution.  The implication is the rest of the country should follow suit, and in a national health care system where funds and standard of care are tightly controlled, certain centers will be responsible for any and all innovations.  Less prestigious academic or private institutions which deviate from the proscribed mantra without prior authorization could be subjected to financial and punitive action.  Ironically and unbeknownst to the author, the Boston miracle he describes may fall short of the performance of the Fresno Surgical Hospital, where total joint patients normally remain in the hospital for only two days following surgery without the benefit of legions of house staff and ancillary personnel.   

Protocols have a place in medicine, but one day’s standard of care eventually becomes obsolete as advances lead to more efficacious care.  Dr. Gawande’s solution to the health care crisis rests heavily on unvarying routine administered by doctors who are employees of large corporations.  In the author’s ideal medical world the physician functions as a waiter serving the same meal over and over again.  The concept of a man or woman practicing medicine independently has no place in Cheese Cake Factory medicine; doctor employees do what they are told and personal initiative, running one’s own practice, and the sixty hour work week become a thing of the past.

I tend to eat at mom and pop restaurants, which offer good service and inexpensive but delicious food and where one knows the owner and staff.  There is a small Thai restaurant in a strip mall at Herndon and Blackstone in Fresno called Gem of Thailand owned by a gracious Thai lady named Gem.

Not long ago my wife and I ordered out on a busy Friday evening, and when we arrived to pick up the food, there was a large backlog.  Rather than ignore us or ask us to take a seat, Gem asked us, “Would you like a glass of water or cold beer while you wait?”  This offer was “on the house” and stemmed from an owner who knows and values her customers.  On more than one occasion I have picked up food after work, only to find when I returned home a couple Singhas stuffed into the carry out bag.

Restaurants like Gem of Thailand represent the opposite pole from Dr. Gawande’s fascination with the Cheese Cake Factory and corporate medicine.  When given the choice I prefer a restaurant which is unique and managed by owners who can put a name to a face rather the cookie cutter model.  I feel the same way about my doctor, as well.