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When policies collide


The author discusses how policies can get in the way of good medicine.

Pretty soon, when another ape tries to climb the stairs, the other apes all try to prevent it. Now, turn off the cold water. Remove one ape from the cage and replace it with a new one. The new ape sees the banana and wants to climb the stairs.

To his horror, all of the other apes attack him. After another attempt and attack, he knows that if he tries to climb the stairs, he will be assaulted.

After replacing the fourth and fifth original apes, all the apes, which have been sprayed with cold water, have been replaced. Nevertheless, no ape ever again approaches the stairs. Why not? Because that's the way they've always done it and that's the way it's always been around here.

And that's how company policy begins . . . .


An ophthalmologist friend possesses qualities (friendliness, intelligence, empathy) that make him a wonderful doctor. He also is an excellent judge of his fellow physicians, as evidenced by his reliably referring to me his patients with complicated corneal and external disease when I used to work at a university in his area. Recently, he told me this story.

"I called the department to refer a patient to Doctor X," said my friend, "but the scheduling person on the phone told me the patient would have to be seen by a different ophthalmologist. 'Our department has a new policy and the policy does not allow for selection of individual doctors. Our policy is that the patient will be seen by the next doctor in the rotation, who is Dr. Y.'

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