George’s Corner

This column has two parts.

The first is about the changing changes that are changing what we do, how we do it, and who we do it for/to.

The second is about how people make decisions. You and me and everybody that we try to get to make the “right” decisions.


“The Only Thing that Is Constant Is Change”

– Heraclitus (Greek Philosopher)

I think we can add: Change is happening fast. And it’s going to get faster.

I remember telephones that had rotary dials, and that you had to talk to an operator if you wanted to call someone in another city. Now I pull out of my shirt pocket a computer that I can use to call just about anyone, anywhere in the world. (It also does a bunch of other stuff for me.)

There are all kinds of changes happening in healthcare. Two basic groups:

1. Things

Just to mention a few:
Smart watches, do-it-yourself EKG readers, automatic insulin administration, fantastic (literally) diagnostic and treatment things. How about injecting something that goes and finds individual cancer cells and explodes them?

If you want to try to keep up with the changes and changing technology in the healthcare world, get a daily update from the Fierce folks at

If you want to know what is in the future, talk to those who are making it. Better yet, be one.

2. What people do

All of the medical professions are changing what they do.
Physicians are closing practices and becoming employees instead of employers. (Side effect is a diminishing AMA influence.) Clinics are popping up and replacing ERs as an entry into the system. Nurses, optometrists, and others are expanding their scope of practice. Patients are communicating with their healthcare providers using the Internet and smartphones to converse, send data, and share images and get faster, better care.


The first thing to recognize is that the basics of human decision-making have not changed. Literally built into our brains are three levels of decision-making: what, how, and why.

The “what” level decides that we want that new Corvette — faster, prettier, and sexier. No consideration of function or basic need. This is the level that most salesmen focus on. It ignores the fact that most of the time I will not get there sooner and that the opposite sex will look but probably not jump in.

The “how” level is more rational and decides based on quantifiable facts. The automobile analogy is gas mileage, cup holders, number of seats, safety. The salesman will use it when “what” does not work.

« FierceHealthcare’s website will help you keep up with the changing technology in healthcare. Visit the website at

The “why” level is deeper in our brain and controls without being recognized. That portion decides on a much more emotional level. The airline pilot has a deep voice, so he must be good. The driver of the Corvette is probably not trustworthy. These are often referred to as “gut level” decisions. Or this is my “heart” speaking. These decisions are made rapidly and are hard to change. The axiom that “You never get a second chance to make a first impression” is built on this truth. Jack Welch says that only two words matter for leaders today: truth and trust.

If, starting with that first impression, you establish that you are always truthful and can always be trusted; your advice will be taken.


As you go about introducing change, make sure that you are not selling the Corvette and have the desired reputation. Then go about explaining how your change is good to the people who are ready to decide because the why has been established. They are ready to buy.

Of course you need to know that your idea is good. Otherwise the truth factor is not trustworthy.

Dr. Oz sells all kinds of stuff because he uses the why level. He is all why. No how or what.

CVS pharmacies is now CVS Health. Healthcare is a why.

Pharmacies are a what.

The Affordable Care Act (ACA) is in place. Those who are still fighting it don’t have any idea what they would do if they won.

CA needs fixing. Costs need to go down and quality needs to go up. All of those deals chronicled in the book that I wrote about in the last issue “America’s Bitter Pill,” need to be repaired. They are keeping costs high and not doing much to improve quality.

Problems are opportunities.

Think of problems as puzzles. (Puzzles are more fun.)

Times of crisis are times of opportunity.

The crisis is the cost and quality of healthcare in the United States.

The puzzle is what can be done about it.

If you want to know what is in the future, talk to those who are making it. Better yet, be one. I believe that you will succeed if you pay attention to the above considerations.

As always, your comments are appreciated. CT

George Pennebaker, Pharm.D., is a consultant and past president of the California Pharmacists Association. The author can be reached at; 916/501-6541; and PO Box 25, Esparto, CA 95627.