An excerpt from ASSUME THE PHYSICIAN: Modern Medicine’s “Catch-22”.

I bled.

With great pride, I skipped the obligatory required mandatory training session on “diversity awareness.” I skipped both the primary session and the make up session. The session, and its mandatory nature, had been carefully announced every day for weeks. The Sheep’s Pen was trying to make a point to JCAHO that they really followed the rules.

I didn’t.  I got contacted by an administrator within a week to go to her office. She was one of the goats, one of the enforcers of rules made by people or organizations to whom we shouldn’t pay heed. I was going to make a stand.

“Dr. Marcus, it seems that you did not make it to either of the diversity awareness training sessions. You do know that it is required, right?”

“Required of whom?” I asked.

“Required of you,” I was told.

“Required by whom?” I asked.

“By JCAHO.  JCAHO requires it. It’s a requirement.”

Hospital administrators are scared of JCAHO and would move heaven and earth, murder pets and children, desecrate holy ground, beat themselves over their heads with the jawbone of their ass, and sacrifice their finest sheep on the altar of bureaucracy in an attempt to avoid getting dinged for minor infractions during a JCAHO inspection.

I knew all about JCAHO, so I asked, “Who’s JCAHO?”

The administrator coughed. “JCAHO. It’s the Joint Commission. THE JOINT COMMISSION for the ACCREDITATION of HEALTHCARE ORGANIZATIONS.”

I guess I was supposed to be scared. I stared at her just as if I wasn’t scared out of my pants. I said nothing. She said nothing. She was big, powerful, intelligent, and useless. A full minute passed before she spoke again.

“You know, the Joint Commission. They are inspecting us any day now, and we have to be on our toes.”

“Why? Are we trying to see over the top of the fence?”

She stared back blankly.

I tried another tactic. “Is JCAHO our boss?”

“No. They are JCAHO.”

“Do we work for them?”

“No. Actually we pay them to work for us.”

I stared at her with an exaggerated expression that I hoped would convey my exaggerated confusion.

“You are the only doctor that didn’t make either session of diversity awareness.” She shuffled some papers. “I see you also didn’t make it to the compulsory essential non-optional module on teambuilding.”

Gosh, I think she was serious. So I stared silently and vacantly in the direction of the space between her ears.

“Do you not understand the importance of these sessions?” she asked me, incredulously.

“What sessions?”

“The training sessions mandated by JCAHO.”

“I guess I don’t.”

“If you don’t go to the sessions, JCAHO will take away our accreditation and the hospital will have to close.”

I had to process the strange notion that an organization that we pay for and has no authority or power somehow has our administrators thinking that it has authority and power to close our entire university hospital just because I am a delinquent.

I sat for a moment before calmly asking, “What’s JCAHO?”

“The Joint Commission!”

“Do they smoke?”

“What?”

“Joints. Does the Commission smoke? Or are they in prison, you know the ‘Joint’? Is it a knee joint, or a shoulder joint? What is ‘Joint’ about the Joint Commission? I bet you don’t even know why the word ‘Joint’ is in their name.”

“Dr. Marcus. I sense that you don’t take this seriously.”

“Your sensors are broken. I do take it seriously.”

“It doesn’t seem so.”

“What doesn’t seem so?”

“You don’t”

“I don’t seem so?”

“That’s right.”

“Good. Then are we done here?”

The large and powerful administrator looked down in frustration at her large knees wrapped in her large black polyester stretchable pants. Or maybe she was looking down in frustration at me. I couldn’t tell.

“So I assume you will take the final makeup session?”

“When is it?”

“Next Friday, at lunch.”

“No, I can’t make it.”

“Why not?”

“That’s when I eat lunch.”

John F. Hunt is a physician and author of ASSUME THE PHYSICIAN: Modern Medicine’s “Catch-22”.