Medical Directors as Pawnbrokers

One of my favorite shows on television is History Channel’s Pawn Stars. I appreciate the nature of what they do – having to know a little bit about a lot, knowing when they don’t know enough to assess the value of something or even know if it is “real” or “authentic”. The pawn dealers know when to call in an expert to help them, much like other industries to advise them on the authenticity and value and worth of an item. Sometimes a Monet painting isn’t and sometimes that first edition printing the seller claims it is isn’t. And sometimes that Civil War relic is real, rare and valuable to a potential buyer and the seller has undervalued it. Often times people think what they have is worth more than it really is – and occasionally what they have they may have actually undervalued and the item is worth more than they had accounted for. And you can actually learn a little history and Americana.

In the opening segment of the show there is the owner’s voice saying that “Family comes before money (he works there with his son and father) – depending on who you ask” and if it is one thing that he has learned from all his years in the pawn shop business is “you never know what is going to come through that door”.

The laboratory business is very much like running a pawn shop – you never know what is going to come through that door.

One day it could be a personnel matter, the next an instrument failure, problem with a specific analyte, upset patient, family member, clinician or administrator, issue with a proficiency test, regulatory issue, industry recall, hospital policy, surprise inspection or a leaky roof.

You never know what is going to come through that door.

There are days of course is when nothing comes through that door. They do happen but more times than not you are not spared. Something is coming through that door.

An instrument is down and the service contract you discussed three months was not renewed. The flu virus has wiped out most of first shift and starting to spread to second and third shift. Your decision to change how a test was reported or perhaps eliminating a test altogether based on low volumes of testing being performed generates more phone calls, e-mails and knocks on the door.

Oh, and the school just called you with an automated message that they are closed due to weather conditions or too many teachers being out with the flu and your child can be picked up in the next 2 hours.

Don’t they know the emergency room is calling you about those stat labs they sent up 3 minutes ago and are wondering where the results are and the instrument just overheated that runs those tests?

And the medical staff meeting or credentialing meeting you were supposed to be at 10 minutes ago is replaced by an irate ER doctor demanding better service. He will later apologize until the next time…

You never know what is going to come through that door.

Just when you think nothing more could happen that day, a supervisor runs through the door with a “we have a problem” statement and a folder of paperwork.

The paperwork lands on the stack of slides waiting to be read from that morning. It also signifies that your promise to be home for dinner at 6 PM will require a text to the contrary.

In a pawn shop, some of the items being brought in to sell or pawn can be quickly appraised with a price that is mutually agreed upon. Commodities such as gold or silver, popular collectibles, common items with known retail values new and used can be dealt with quickly. A deal is either done and the item stays in the store in exchange for money or the seller leaves the store with his/her item unsold to the shop.

In a laboratory, some of the issues can be resolved quickly, delegated or handled personally. Decisions about workload, staffing considerations and downtime issues often times have to be dealt with on-the-spot and everyone tries to do the best with what they have. Some issues that have lingered before they hit your desk are going to take longer when discovered and brought to you. Experts or consultants or more information may be needed.

Sometimes the problems are not as big as they may seem to some. Sometimes they don’t recognize what they bring you is actually a small problem but has potential to become a huge problem. The “worth” of the problem can be under- or overestimated.

In the end, just as with Pawn Stars, sometimes a fair offer can be made that is mutually agreeable and can be done so with little effort or outside opinions. Sometimes the negotiations take longer and require more input to problem solve.

But what fun would it be in either business to actually know what is going to come through that door?