As a slight respite from writing about how psych is affecting how I view medicine and myself in medicine, I wanted to share this darkly humorous game that I read about on a great blog written by physicians about health policy. I love board games and they've been a great escape when we're out of the hospital into a land of set rules. This one might be a little too close to home...
While I hope to never actually practice medicine like this, it is a cynical view at the way our current system asks doctors to think about patients, treatment, and their own financial stability.
The game is called "Quack in a Box" and was designed by an internal medicine doctor in rural PA. The basic idea is that all the players are doctors and each round you try to treat your patients. For each turn, you roll a die which determines the number of treatments you have to give your patients. You don't necessarily have to be treating the actual disease (what?!) but you just can't kill your patients or there are negative consequences. For example, exploratory laparoscopy (basically an opening up of your abdomen and looking around) kills very few patients, and costs your patient $2000, whereas completely a thorough physical or recommending prenatal vitamins to a pregnant patient, or yoga to a patient in for a check-up will earn you "cure points" for the patient, but as the doctor you earn $0.00, making it harder for you to treat anyone else.
If your patient gets cured, regardless of how many of the treatments you did were actually helpful, they pay you in full. If your patient dies, you accumulate "infamy" (malpractice suits?), too much of which will destroy your practice. The crazy thing is different patients are worth different amounts of infamy. If you accidentally kill a 60 year old homeless man with schizophrenia, 1 infamy point - but a 35 year old physician with two kids, 7 infamy points.
It's sick, really, but from the review by the doctor on the website - and everything I've seen and heard in our medical system in the US - it might not be so far off the battle that physicians fight daily.
Please let's change this. Step 1: do not privatize or kill medicare! (more on this soon)
"anytime you feel the pain, hey jude, refrain
don't carry the world upon your shoulders
for well you know that it's a fool who plays it cool
by making this world a little colder"
-the beatles, hey jude