SKIN IN THE GAME

habitat for humanitySKIN IN THE GAME

By Chet Yarbrough

3/7/13

It’s 6:00 A.M.– getting ready for red-shirt volunteers at a Habitat for Humanity’ construction site.  It is a sunshiny day in September 2009 that will push heat above 100 degrees by 12:30.

The Project Manager prepares a work site for a handful of experienced group leaders that will help future homeowners, their friends, and a dozen inexperienced volunteers build a house for a working family that needs a home but cannot afford a conventional mortgage.   Habitat for Humanity is an international success in the shelter business because every home buyer has “skin in the game”; i.e. every home-built to be sold to a working family is partly built by that family.

At 61 years of age, it’s a dream job with little stress and a work environment that employees feel privileged to experience.  The privilege is in the joy that comes from working with people who need shelter and volunteers that want to do good for others.

Unlike past early mornings, the Project Manager is feeling oddly weak as he opens job boxes, lays out tools, brews a pot of coffee, and sets water out for the day’s work.  After sitting down, the weakness disappears and the day goes on but the Project Manager makes an appointment to see Dr. Feelgood, his general practitioner, to get some advice on what happened earlier.  (Doctor’s names are fictitious and are not meant to either praise or blame any real person.)

Dr. Feelgood gives the Project Manager an examination and refers him to a cardiologist.  The Cardiologist, Dr. Dewit, examines the PM and schedules him for a stress test and electrocardiogram.  Dr. Dewit is new to the PM but is recommended by Dr. Feelgood which gives the PM some confidence in Dr. Dewit’s ability.  In a follow-up appointment, Dr. Dewit recommends an angiogram be done.  This is the second time the PM has met Dr. Dewit.  Dr. Dewit explains the procedure which involves being anesthetized, and injected with a dye that is squirted into a femoral artery in a patient’s groin.  The PM explains to Dr. Dewit that he does not want a stent automatically inserted if blockage is found in an artery.  The PM wants to discuss the results with Dr. Dewit before a stent is installed.  Dr. Dewit reluctantly agrees.

Dr. Dewit reviews x-rays and concludes that a stent is the solution for an apparent blocked artery.  The PM reluctantly agrees. The doctor operates, once again. Dr. Dewit, for the first time in his career, is unable to force the stent through the blocked artery.

The PM recovers from the second trip to the operating room.  Dr. Dewit looks at the x-rays again. He advises the PM that he missed the fact that collateral arteries developed around the occluded artery and were serving that part of the heart that had been served by the diseased artery.  The stent was not necessary.

Revelation #1—Doctors are not wholly good or bad; they, like all human beings, are motivated by money, power, and prestige.  Doctors make mistakes.  Patients make mistakes. Human beings are not immortal and life is ephemeral.  Luck, both good and bad, accompanies good and bad decisions made by both doctors and patients.

The former PM is now a retired, 65-year-old, seeing a new general practitioner and a new cardiologist.  In follow-up examinations, there are some changes in his electrocardiogram with some chest tightening when the PM hikes at higher altitudes.  No stent yet but the new cardiologist wants to do another angiogram with authorization from the PM to implant a stent if further blockage is revealed.  So far, the PM’s decision on another angiogram and possible stent is no.  Stay tuned because Dr. Goodforme, the new cardiologist, wants to see the patient again in 6 weeks.

Life is a gamble but it is a patient’s gamble, not a practitioners’.  Who knows what the proportional motivation is for a practitioner?  A patient’s motivation is health which allows for continued pursuit of money, power, and prestige.  A doctor’s motivation is the same; only diminished or increased by the next willing or un-willing patient, but it is the patient who has skin in the game.

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