February 5, 2012

The ICD-10 Tale: Act II

By David Block, MD, PhD

EDITOR’S NOTE: David Block, physician, mediator and erstwhile playwright, continues with Act II of his “The ICD-10 Tale.” Act I has been archived and can be accessed using the Search button on the ICD10monitor home page.

Act II, Scene 1:

(The scene: It’s Tuesday night at the meeting room of the Moonlight Bar-B-Q and Karaoke (“Y’all come and share our home”). Everyone from the last meeting has packed in elbow-to-elbow: that’s part of the Moonlight attraction. Family-friendly, the whole town often flocks to the place, especially service organizations – but never drug reps or consultants. A seasoned “YELPER,” the mediator had looked carefully for an inexpensive venue familiar only to disputants, as it would set a tone and establish certain values. He had turned down the local country club when Crossroads Medical offered it, much to the CEO’s surprise: “You’ll learn.  Give these doctors a steak, and you have them where you want them.” The Moonlight, though? “My CFO will represent me.” There are no ties, no white coats, no armed camps eating barbecue.

The mediator arrived early to meet people, he said, but really to watch how the room filled. Who would sit with whom? Would there be physical contact and eye contact in this less threatening atmosphere? Would there be smiles, or just aimless BBQ and peach-cobbler grazing? If everybody accepted the choice of the Moonlight and embraced its friendly and permissive atmosphere, he would take that as a hopeful sign of engagement.

He studies Marie and Fritz sitting at the same table, engaged in different conversations but aware of each other. There’s Dr Frootlupe – always “Dr.,” but his tie is loosened.  The CFO is in jeans and a red snap-button shirt: cool! The mediator hears a familiar voice … enter Corey Sue Lachienne and Axel Avocat.)

Corey Sue: Ah, there’s the anthropologist doing his fieldwork … David, don’t you ever just eat?

David: Not when there’s work to do. Anthropologists say anything you find can be an artifact – food, manners, using one word instead of another, websites, snap-button shirts – then every artifact tells you what folks value, and every value tells you what they believe must be true about their world. Values and assumptions speak about their culture. And that also tells me about their conflicts, real and imagined, but also about connections and possible resolutions. You and Axel do that without thinking. Slobs like me have to write it out. But it’s also why we get invited back.

(The CFO stands and asks for attention. He wipes his hands and mouth, leaving napkin shreds, then shrugs and smiles. Everybody laughs; then realize that they, too, are as sticky. They pass around toothpicks and push back from the table.)

CFO: Thank you for coming back, folks. Everybody’s here from last week. That tells me we all recognize the importance of this ICD-10 stuff. (Cue loud groans). This is a kick-off dinner. The real work begins next week – David, our mediator, tells me we’re going to meet in three groups. Now I’m turning the meeting over to David and his friends so I can get back to dessert. Serious dessert. (Smiles, sits,)

David: Evening, folks. I also want to thank you for being here. And I’d like you to meet my partners, Corey Sue Lachienne and Axel Avocat – nope, not named after Axl Rose. They’re going to help you all figure out what solutions will work best. Corey Sue is a professor at state university in social psychology. Axel is an immigration attorney and an active mediator for the courts. (Both wave.) And Corey Sue wants to say a few words.

Corey Sue: Evening, y’all. We’ve got important work to do here tonight, even before we break up into smaller groups next time. Tonight is pre-work, but critical for us all. At State U – I know many of you went to school there for medicine, nursing or business, or just came up for, um, study time (smiles, blushes from the audience) – our research shows that we all need a common language to describe what our conflicts are all about so everybody can understand and accept the resolutions. And it comes down to five main word drivers. Status: how we see our roles in every group we’re in.  Certainty: what we can count on being valid and true so we’re more secure.  Autonomy: do we feel we’re free to do what we should do? Relationships: how do we feel like we’re part of a group at all, and not just alone? And fairness: do we think we’ve been treated fairly? Simple as that. Just about all deep conflicts, like this one, come down to one or more of these five – status, certainty, autonomy, relationships, fairness. S-C-A-R-F. But it works for marriages and love, too; or kids and plumbers, CEOs and baseball players. If people want to live together after the outcome, it’s a SCARF issue.

Neurologist (Shouting out): Is this just that “Getting To Yes” book?  My kid read that for one of his classes at that expensive college up north. Didn’t work for him. He left it at home. “Getting to Yes.” (Snorts. Some around him look uncomfortable.)

Marie, head of HIM (Stands, fixes everybody with an electric gaze): Well, I don’t know what this “Getting to Yes” is all about. And Benvenuto, we’re all sorry you had to pay your son’s awful tuition – it wasn’t fair, getting stuck with the bill, the book and just a T-shirt. But I know this: “Getting to Yes” is not our story. It’s “Getting to Us!” That’s U-S, and it’s way past just Y-E-S for CMC. If these folks can help us find a way, we’d better learn that SCARF and give it a try. (People look at each other, agreeing that she’s right.)

(Dinner breaks up. People file out through the bar. The CFO and the vice president of nursing take over the karaoke machine, make a choice, wait for the music and start singing “Love Will Keep Us Together.” Fritz and Marie regard each other and leave by different doors. Dr. Frootlupe stops, sits, keeps time to the music. He signals for the waitress. The stage darkens.)

About the Author

David Block is a physician and has a PhD from New York

University. He taught linguistics and medieval literature for three years in Illinois before entering the Abraham Lincoln School of Medicine at the University of Illinois, graduating with honors in 1979. He is a registered neutral in the State of Georgia and is a founding partner of HealthCare Mediation, LLC, in Athens, Georgia.

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Read 83 times Updated on September 23, 2013