Suits

01/18/24 • 10 min

If you want to see writing exhaustion, this is the series. After two pretty decent seasons, the show devolved through the ensuing six as if the writers had become deprived of oxygen. Every time someone knocks on a door, the response is, “What are you doing here?” It’s not, “Good to see you,” or “How can I help you?”, or “Are you lost?” People discussing matters in a private office are interrupted with a solution or dramatic new information by a colleague simply traipsing in from the halls. There are continuing confrontations and apologies, prefacing further confrontations and apologies, between and among the same people, often multiple times per show. People hard to reach are ambushed in the streets—outside their offices, at hot dog carts, in public garages—as if they were on a schedule and could easily be found. Similarly, people barge into private offices in other buildings without bothering to go through security or secretaries or assistants. And the person being accosted says, of course, “What are you doing here?” All the women, from the stars and supporting cast to the extras wear stilettos all day long. I’m assuming the producers have a fetish about this. (And the clothing is out of Vogue and hugely out of place as office attire.) I’m told they’re trying to conjure up a ninth season. If this appears on any of my streaming platforms I’m going to ask, “What are you doing here?”

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Healthcare

• We’re seeing huge changes in healthcare. • About 25% of patients used telehealth last year, far exceeding the 5% who accessed care this way before the pandemic. • Pharmacies with physicians present (like pet stores with vets present) • Physicians in private practice greatly reduced. • The share of doctors who worked in practices wholly owned by physicians fell from 60.1% to 46.7% from 2012 to 2022. • More people seeing nurse practitioners • From 2016 to 2021, the number of primary care physicians billing Medicare declined each year, from 142,000 physicians in 2016 to 135,000 physicians in 2021. • Physicians tell me that the paperwork, reimbursement bureaucracy, and corporate demands are terrible. Example: 5-8 minutes allowed for patient questions during visits. • Some exceptions: dermatologists have modestly increased. There are no midnight emergencies for dermatologists. • Faith in the medical establishment has been undermined by the conflicting medical and political decisions during and after COVID. • Religious institutions, education, and medicine have all suffered damage to their integrity. • Patient costs are rising in terms of copays and over coverage denied by insurers. • The limited government data available suggests that, overall, insurers deny between 10% and 20% of the claims they receiver • When I consulted with RI Hospital it started every year in the red by $14 million because they were required to provide care to indigents. • Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States, making medical errors the third leading cause of death. • Sepsis is a leading cause of death in hospitals. • Emergency room waits can be 12 hours and worse. • It wasn’t all that long ago that doctors were not washing their hands between seeing patients!

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Discipline

One of the major issues with a lack of success is that people don’t hold themselves accountable. They fail to meet deadlines, fail to fulfill obligations. They put more work into making excuses than they would have doing the actual work. The old “dog ate my homework” is now “there was traffic,” “we have child care issues,” “my internet was down.” There are no consequences for our failing our own accountabilities, and no rewards for meeting them. I’ll get around to it, unless I decide not to. Symptoms include lateness, unpreparedness, seeking last minute help or replacements, begging for more time. If you don’t think this is systemic as well as individual, think of Pearl Harbor (or 9/11, when flight schools had Muslim pupils who wanted to learn how to take off, navigate, and fly, but not land). We are unorganized and rarely penalized for it. We are able to blame others or the system of the deep web or some conspiracy, somewhere. Occupy Wall Street, Soak the Rich, down with Big Pharma. And, eventually, these people justify their lack of discipline by pointing out they can’t achieve anything because they’re not getting a fair shot. That’s what happens, of course, when you’re a dollar short and a day late.