The Executive Suite: 17 inches: Health care lessons from a college baseball coach

As healthcare has become more complicated, physicians are often asked to perform tasks and accept decisions from others that negatively impact the doctor-patient relationship. I am certain that there are times when we are put in a position by our patients, our staff, our colleagues, and payors to bend the rules or to make concessions that are not always in the patient's best interest. We have been in situations where we are forced to compromise on what we should do and end up accommodating others out of expediency. I want to share a speech by baseball coach John Scolinos, legendary baseball coach for Pepperdine University, who gave advice from his many years as a baseball coach and advice that can apply to all of us in the healthcare profession.

Coach Scolinos was invited to address the American Baseball Coaches Association's convention.

He said, "You're probably all wondering why I'm wearing a home plate around my neck. I stand before you today to share what I've learned about home plate in 78 years in baseball." He began by asking how wide the baseball home plate was for Little League, and someone in the audience answered, "17 inches." He then asked about the plate width for high school, college, and major league baseball, and the answer was always 17 inches.

Scolinos asked, "What do they do with a Major League pitcher who can't throw the ball over those 17 inches?" After a long pause, he said, "They send him to play in Siberia or the Minor Leagues."

"What they don't do is say, 'We'll help you out and make it 18 inches or 19 inches. If that still doesn't work for you to throw strikes, we'll make it 20 inches, so you have a better chance of hitting it. If you can't hit that, let us know so we can make it even wider, say 25 inches.'"

Scolinos asked, "Tell me, what do we do when your best player shows up late to practice? What is your reaction when your team rules forbid facial hair, and a guy shows up unshaven? What if they are caught drinking? Do we hold them accountable? Or do we change the rules to fit them? Do we widen home plate?"

Coach Scolinos continued, "This is the problem in our homes today. With our marriages, how we parent and discipline our children. We don't teach accountability to our kids, and there is no consequence for failing to meet standards and follow directions. What we do is widen the plate!"

He paused, then pointed to the top of the house, removed a red and blue Sharpie, and drew a small American flag. "This is the problem in our schools today. The quality of our education is going downhill fast, and teachers have been stripped of the tools they need to be successful and to educate and discipline our young people. We are allowing others to widen home plate! Where is that getting us?"

"If I am lucky," Coach Scolinos concluded, "you will remember one thing from this old coach today. It is this: if we fail to hold ourselves accountable, a standard of what we know to be right; if we fail to hold our spouses and our children to the same standards; if we are unwilling or unable to provide consequences when they do not meet the standard, and if our schools and churches and our government fail to hold themselves accountable to those they serve, there is but one thing that will occur "… dark days are ahead!"

His message can be applied to the practice of medicine. We fault young doctors for only working eighty hours a week and not developing the resiliency that older physicians experienced as young, training doctors. Our burnout rate exceeds 50% of physicians, fellows, residents, and even medical students. Yet, many in our profession still need to address this problem, which has reached epidemic proportions.

We expect patients to accept that the doctor is 30-60 minutes delayed in seeing patients because the previous patients took more time. We can do better; the plate is still seventeen inches!

We tolerate employees who do not dress professionally. We don't admonish staff using their cell phones while at work and checking their Facebook non-medically related messages.

We have accepted insurance companies denying requests for procedures and medications that are appropriate for patients without reacting to the fact that this is not in the best interest of our patients.

We have tolerated being told we cannot communicate with patients about their weight, smoking status, and lack of exercise because it isn't politically correct.

We have all accepted patients calling us in the evening or on the weekends asking us to refill their medications that they have been using for months or years but forgot to call during office hours. When we asked for the number of their pharmacy and agreed to refill their medications, we lowered the bar and increased the plate size. You can be sure the patient will call you again at their convenience rather than yours.

Bottom Line: Coach Scolinos's message resonates way beyond baseball and has applications for the entire healthcare profession. Let's begin questioning what our country, government, and profession have become and how to fix it. Coach Scolinos' take-home message is, "Don't widen the plate; it's still 17 inches!"