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The re-release last month of the movie "Titanic" marked the 25th anniversary since the film first sailed into theaters. Can you believe it? This fictional love story of Rose and Jack was intertwined with the actual events of the Titanic's demise -- it was "the ship of dreams."
It took 3 years, over 15,000 workers, and approximately $7.5 million (up to or more than $400 million today) to construct the Titanic. At the time, it was an engineering marvel, the largest moving object in the world. It was 100 feet longer and over 50% heavier than any other ship. It was considered "unsinkable" due to its revolutionary 16 watertight compartments in the lower section and a hull made of one-inch thick iron plates.
"God himself could not sink this ship" -- a comment made famous by the film but that is believed to have been made by a deck hand
The Titanic was thought to be unsinkable, yet sank in just a few short hours on April 15, 1912, after colliding with an iceberg in the North Atlantic Ocean. Over 1,500 lives were lost on that tragic day.
Is medicine doomed like the Titanic? Some would say that medicine is on the brink of hitting an iceberg that might take down the entire U.S. healthcare system. Like the Titanic, many lives would be lost.
You don't need to be Six Sigma certified or have an MBA to see the parallels between the ill-fated Titanic and our current state of medicine. Let's review the six reasons the Titanic was doomed on that fateful night and note how our healthcare system may be headed on the same course, directly into an iceberg.
1. Egotism: The captain of the Titanic received at least six warning messages about icebergs from other sailors in the area. Instead of slowing the ship and changing course, however, he went full speed ahead at 20.5 knots (23 mph) without changing course, making it more difficult to maneuver a large ship around an iceberg.
In the case of healthcare, physicians have been preaching to healthcare administrators and legislatures about the foreseeable demise of the healthcare system. Yet, many of us feel like our warning signs are being ignored. Some physicians that can offer great solutions to our problems fear being silenced or labeled a "problem doctor" by an industry that values profits over patient care.
2. Outdated processes: When the iceberg was spotted, the captain called out "hard a-starboard," which meant the boat would go in a rightward direction to avoid a collision. The helmsman, who steers the ship, turned the wheel clockwise, inadvertently turning the boat to the left. Back then, you had to turn the wheel in the opposite direction so that the rudder would go in the opposite direction you wanted to steer the ship. This was an archaic process that sailors were familiar with, but that is not applicable to steering a steamship.
Physicians commonly hear, "That's how we have always done it." That's an outdated reaction from administrators to fixing our current problems. We don't need more meetings to solve our healthcare problems; we need action. We need to update the way we do business. Without updating their steering systems to match the innovation on the Titanic, the ship was a disaster waiting to happen. Is healthcare next?
3. Substandard materials: The composition of iron that made up the Titanic's hull was very brittle in extremely cold weather, making it prone to fracturing.
In medicine, we are struggling with the cost of supplies, leading us to consider cheaper ways to provide care without the best products and tools. We must find ways to debulk the current system of middlemen and work directly with cost-efficient manufacturers to make it easier and less expensive for physicians to get their hands on the right equipment to treat their patients.
4. Design flaws: Although the Titanic was designed to have 16 water-tight compartments in the lower section, they were poorly built. Water could leak from one compartment to another, leading the ship to lose its buoyancy and to sink.
The current system of staffing in healthcare needs to be revised. The system must develop newer ways to staff facilities without temp agencies that add excessive costs to the system.
5. Poor vision: Not only was the Titanic cruising on a moonless night with only the northern lights providing some visualization, but the crew was also without binoculars. Due to a little mishap, the keys to the locker with the binoculars were left at the dock.
In healthcare, our motives to make money and earn significant profits will skew our vision of providing excellent patient care in the future. We have too many people not directly involved in patient care steering the ship, resulting in muddled messages. We need transparency within the industry so we can all work together rather than being led in the dark.
6. Budget cuts: It is rumored that when the builders of the Titanic went over budget, they chose to spend more on luxury items on the inside of the ship rather than on the outside. This may be why there were safeguards lacking, such as enough lifeboats to save everyone, water-tight compartments to prevent the ship from sinking, and higher-quality hulls to withstand cold temperatures.
With healthcare systems cutting corners to drive profits, the concern should be that patients will suffer. Like the lives lost on the Titanic, more families will fall victim to the healthcare system if we don't find ways to cut the fat out of the system. The emphasis should be on spending money on those providing direct patient care rather than lining the pockets of those in the insurance and pharmaceutical industries.
"I feel like I'm standing in the middle of a crowded room, and screaming at the top of my lungs, and no one even looks up." – Rose
Since the sinking of the Titanic, numerous safety measures have been implemented on ships. The International Convention for the Safety of Life at Sea (SOLAS) ensures that all ships have watertight compartments, lifeboat drills, emergency lighting systems, and other safety features. In addition, the International Ice Patrol was also created to alert ships of icebergs and have updated iceberg detection services.
"Titanic, name, and thing, will stand as a monument and warning to human presumption." – England's Bishop of Winchester, in a sermon the Sunday after the disaster
The sinking of the Titanic is a powerful metaphor for the potential collapse of medicine. Like the Titanic, the medical system is fragile, and it is becoming increasingly clear that it is doomed to fail without proper attention and vigilance.
With an influx of more complex patients and staffing shortages, medicine cannot keep up with the demands being placed on it. To prevent further decline and ultimate failure, we must take proactive steps to address the many challenges that face the industry today. It's time to change course!
As we all strive to play our part in providing comfort and care to the human race, we must learn from the many lessons of the Titanic.
Aaron Morgenstein, MD, is a board-certified orthopedic surgeon and founder of FlexMedStaff.com, a fully transparent and free marketplace for physicians to find new clinical and non-clinical opportunities to improve work-life balance. Corinne Sundar Rao, MD, is a board-certified internal medicine physician and founder of Legacy Physicians, which helps hospitals find well-qualified physicians at a much lower overhead than they would pay staffing agencies. Shreekant Vasudhev, MD, is an internal medicine physician.
This post appeared on KevinMD.