H E A L T H L A W Pull Up! Pull Up! ■ JOHN SHUFELDT, MD, JD, MBA, FACEP I am often asked what inspired my love of flying. Although this is the first time I have admitted it in public, I am proud to say that it all began with the movie Airplane! Dr. Rumack: You’d better tell the captain we’ve got to land as soon as we can. This woman has to be gotten to a hospital. Elaine Dickinson: A hospital? What is it? Dr. Rumack: It’s a big building with patients, but that’s not important right now. As it happens, this was just the first of the movie’s many take-home messages. The deeper meaning, along with my love of flying, grew steadily over the ensuing years. One thing I have learned is that there is always more to learn. My most recent aviation education experience took place at Flight Safety International. It was an intensive program de- signed to offer students a “type-rating” in a particular aircraft. When I first arrived, I thought, “How hard can this be?” The answer came in short order; it turned out it could be, and was, hard! Typical days were 12 hours long, consisting of in- tense classroom sessions, self study and flying realistic, full-motion simulators. Once, when my flying partner crashed on takeoff during a simulated engine failure, the instructor offered, "Don't worry, you're fine. You are so far behind the plane that you are still in the terminal.” Looking back, I can’t imagine how I learned so much in such a short period. Along with the necessary skills and knowledge related to flight, I gained some insight that is readily applicable to the business of urgent care: 1. It is possible to make large course changes in a short amount of time with incomplete data. The newer, John Shufeldt is the founder of the Shufeldt Law Firm, as well as the chief executive officer of NextCare, Inc., and sits on the Editorial Board of JUCM. He may be contacted at JJS@shufeldtlaw.com. w w w. j u c m . c o m glass cockpit airplanes often have an instrument called the Traffic Alert and Collision Avoidance System, or TCAS, to identify other airplanes in close proximity. Once a con- flict is identified, the pilot may be required to take imme- diate evasive action by abruptly changing course or alti- tude. The pilot must be quick and decisive. “Analysis paralysis” can prove fatal. Dr. Rumack: Can you fly this plane, and land it? Ted Striker: Surely you can’t be serious. Dr. Rumack: I am serious...and don’t call me Shirley. Analysis paralysis is the condition caused by re- peated and often unnecessary data collection and dis- section down to the minutia. In the urgent care business, this commonly mani- fests as an indecisive manager stalling interminably to “analyze data” in an attempt to avoid appearing inef- fective. As is the case for the pilot, you must learn to analyze, decide, and take action efficiently. Too often, businesses will languish while the data are collected. 2. When you are off course, you have a very short, fi- nite amount of time to correct the heading before you and your passengers meet with a terrible out- come. When a plane is on an “instrument approach” (managing the flight path based on data from instru- mentation), the margin for error is minuscule, and the pilot must monitor closely to keep the plane on the glide slope. Failure to do so could be catastrophic. Rumack: Elaine, you’re a member of this crew. Can you face some unpleasant facts? Elaine Dickinson: No. When things are not going as planned in the urgent care center, waiting until the metrics are far off before initiating course corrections can be equally catastrophic. If, for example, visits are down—thereby impacting revenue—you must take action immediately. Start by JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | M a y 2 0 0 9 41