Stanley Feld M.D.,FACP,MACE
My son, Brad, has done it again. He is continuously giving me new ideas.
During our most recent visit to Boulder he said “Dad, your blog is great! You are explaining the problem and expressing ideas that should be adopted by the healthcare system. However, the blog is missing your personality.” I was perplexed. He went on to say that my blog needed to express more of my personality. “You have so many great stories about your past which reflect your personal development. These stories should be shared with your audience because they are funny and educational. These “Feld-isms” have inspired me and others. Your blog will then reflect your personality and have greater impact.”
Brad’s suggestion came on the heels of my meeting an old friend a few days earlier in an Art Gallery in Santa Fe. I had not seen Tom McConnell in years. Tom McConnell M.D. is a pathologist. He told me about his life long fantasy to become a writer. During his childhood his father rejected his fantasy so he became a pathologist. He recently began a web site called “ Notes from a Life”. His stories are a riot. “Paratrooper Circumcision” is the funniest and a worthwhile read. Our conversation lasted almost two hours and we have a luncheon date on August 24.
Since I was talking about Diabetes Mellitus and how a high blood glucose level pickles proteins in the body I felt it appropriate to tell you about Jake the Pickle Man.
So here goes. Every Saturday afternoon during my childhood my parents and my brother and I went to visit my grandfather (Pop) and my grandmother on Charlotte Street in the Bronx. Charlotte Street was a street perpendicular to Jennings Street. Jennings Street was a street of food markets just after WWII. There were two butcher shops, two milk stores (dairies), two bakeries, and two fruit and vegetable stands. There was only one sour pickle stand. Jake’s Pickle Stand.
Jake’s Pickle Stand was located in the alley between two buildings. Pop taught my brother Charlie and me one our first business lessons. Pop told us when you have two stores selling the same thing it is good for the customers. The store owners have to compete and be innovative to attract the customers’ business. I doubt Pop used the words compete and innovate to a four year old and a seven and a half year old. However, we understood his point.
Jake had a monopoly. He was the only Pickle Man for miles. It probably did not matter whether Jake had competition or not. Jake made the best sour pickles and sour tomatoes in the Bronx and probably in the universe.
However, Jake had a funny way of marketing his product. He did not do any marketing. If he did not like you he charged you a lot for a sour pickle. If he really did not like you he would chase you away from his pickle stand.
My grandmother always made a large Saturday evening dinner for the family. Naturally we needed sour pickles for dinner. Jake did not like my grandfather very much. Sometimes he would give him only one pickle for a quarter.
My grandfather was very smart and innovative in his own right. He decided to send Charlie and me down to Jake’s Pickle Stand with two pickle jars. I got the bigger jar because I was the big brother. My brother was too small to carry the large jar. Pop gave me fifteen cents. He gave Charlie ten cents. He told us to go stand in line and buy sour pickles from Jake. You have to understand that Jake’s pickle line was longer and slower than any Starbucks coffee line in the country.
We both waited in line patiently. Mrs. Jake, with her four diamond rings, noticed us and whispered something to Jake. I was in front of my brother. At my turn I asked Jake for fifteen cents worth of pickles.
Jakes counting methodology floored me. The first pickle in the jar cost four cents. After he put the second pickle in the jar I only owed him two cents. With the third sour pickle I owed Jake five cents. After adding seven more pickles to the jar I had spent the fifteen cents. Jake filled the three quarter full pickle jar with delicious pickle juice.
Next, it was Charlie’s turn. He had a smaller jar and only his ten cents. Jake started counting ten cents worth of pickles for my brother’s pickle jar. Jake stuffed 14 pickles into Charlie’s smaller jar. Jake could hardly fit any pickle juice into that jar. Our family had plenty of pickles for Saturday night dinner and for the next week as well.
Charlie and I did this week after week. The people in line in back of us were amazed. A seven and one half year old and a four year old walked away with a greater number of pickles for twenty five cents than the total number of pickles any six in line would receive for a quarter a person.
There are at least three business lessons the healthcare system could learn from Jake the Pickle Man. Pop understood Jake’s psyche. Jake did not have children. We were cute and bold. He liked us. Therefore he gave us plenty of pickles for a low price. He did not know that Pop was our grandfather. If the vendor likes you for some reason, your chance of getting a better price in a non market driven environment is better than the person a vendor does not like. Therefore the most efficient markets are truly competitive markets. They should also be consumer driven. Healthcare is not a competitive marketplace and it is not consumer driven.
Do not make Jake mad at you. The moral is do not make the people in power angry. They can ruin your goals. It is constructive to present people in power with ideas that will help improve their business. In the healthcare system the idea should be to align the facilitator stakeholders’ incentives with the primary stakeholders’ incentive, namely the consumer of healthcare. It is difficult to force people in power to be reasonable and fair. Jake the Pickle man would not budge if he did not like you. In the healthcare system the consumer and the physicians are starting to realize that they really have the power. The facilitator stakeholders in the healthcare system are forcing them to do things they do not want to do. These actions, I fear, will lead to more trouble for the medical care system.
I believe most events in life have multiple meanings. The story of Jake the Pickle man illustrates this belief. The healthcare system should learn something from the story of Jake the Pickle Man.