House of Cards-iology


“Stay with me. Don't ask me any questions. I'll tell you what you need to know. You do exactly what I say, and you won't end up back in Poughkeepsie running a weight loss clinic. The Department of Cardiology is in disarray and we are going bring order to that chaos. See that big red heart with the four circles: clinical, research, education, and administration? You remember that; then forget it. It's not about patients, or empathy, or evidence-based care. Those things are fine, on the ward. They are laudable goals and the epitome of the medical profession. But this is about budgets and revenue and power. We are going to make some things happen.”

Dr. Nathaniel Overtree strides down the hallway, his administrative intern trailing behind him. He nods at acquaintances, warmly shakes hands and pats the backs of cronies, smiles at small children (with just the hint of an internal grimace), and gives a narrow-lipped smile to everyone else. He pulls out his phone and scrolls down his schedule for the day, deftly avoiding eye contact with Dr. Roger Ready, head of the cardiac catheterization lab, as they get on the elevator together. He turns to his intern and asks for the agenda for the Space Committee. He reminds the intern to get him that summary of new Medicare procedure data.

Illustration by David Rosenman
Illustration by David Rosenman

As they exit the elevator, Dr. Overtree pretends to now notice Dr. Ready. He asks if Dr. Ready's son has heard from the medical school admissions committee yet, then assures him that although acceptance is guaranteed, he'll make a few calls and put in a good word.

Dr. Overtree and the intern walk down the hallway. “Hurry up, you're falling behind. Yes, I do happen to know the administrator for the medical school. I got his wife a job in Human Resources. Ready may be a giant in the field of cardiology, but he is a blind fool when it comes to his son. I know for a fact the boy is a certifiable genius. He got in 2 weeks ago, but for some administrative reason the acceptance has been delayed. I suspect they will hear now in a day or two. That's a quid pro quo, with just a little quid on my part.”

Dr. Overtree grimaces and tells the intern it's time for a little coalition building. The Practice Committee for the Department of Cardiology will begin meeting in 15 minutes. Dr. Overtree works the pre-meeting crowd. He pulls an electrophysiologist aside. He tells him he's heard that the Information Technology unit is planning to completely revamp the admission order set and documentation pathways for angioplasties, but the Pacemaker and Device Service is not going to be included on the project. It's slated for phase 2. Limited IT resources. The doctor gets agitated, but Dr. Overtree calms him down. He tells him to trust him; he has contacts on that committee and he'll make sure that they include someone from his service in the next meeting.

Dr. Overtree barks at the intern: “Yes.” He smiles. “I know there is no phase 2. You have that data from the Space Committee? Who is getting that fine corner office? Dr. Rudson? I want that office for Gergorsen from the EKG lab. He's a pompous idiot, but he's my pompous idiot, and I want him to have that office where I can keep an eye on him. It will make him feel like a king. But what shall we do to dislodge Rudson? Get me Al Jordan at Duke. Perfect.”

He takes the phone from his intern. “Al, how's the wife and kids? That dog still hunt? A fine specimen of canis. Say, listen, you still need an echo guy? You have one almost set? I hear Rudson may be looking. Why not send out some feelers his way? But please keep me out of it. I'm just trying to do a favor for a friend. See you soon, Al.”

He turns to the intern. “OK, while I'm in the meeting you find a phone, and at 1:10 exactly you page Dr. Stresnal. You text him a different message every 30 seconds until the meeting is over: His car is ready, his patient is here, his wife is on the line. Do it from the phone in Dr. Litmar's office. Yes, I know the source of the calls can be traced. And yes, I know Litmar is going to miss the meeting. His secretary needs a new computer, which I mentioned I might be able to provide. She, in turn, noted he would be having lunch with a physical therapist, who happens to not be his wife. I told you not to ask questions.”

Dr. Overtree enters the committee room. A new staff member occupies his favorite seat. Dr. Overtree stands over his shoulder and glares at him. The new doctor looks up and meets the steely glare with a smile. He gets up and pours himself a coffee from the counter, pretends to get a page and walks out of the room, then returns and takes a seat closer to the door. He says he needs to be near the exit, because he has a big case. Dr. Overtree smiles. This is a new man he can work with. He nods slightly, and a connection is made.

The agenda is full, but the last item is key. It's time to select a new representative to the Compensation Committee. Dr. Overtree counts the votes in his head. It will be close. They are about to call the vote, and that's when Dr. Stresnal's pager starts to beep. He leaves the room and does not return. Without Dr. Stresnal's vote against him, Dr. Overtree gets the committee spot. Mission accomplished.