Mimicking MacGyver in the Oncology Clinic: Improvisation and Creative Solutions, Only Rarely Involving Duct Tape
Authors: David P. Steensma
Journal: Journal of the National Comprehensive Cancer Network (2015)

Among the most popular television series in the late 1980s was MacGyver, an ABC action drama that followed the adventures of gun-averse secret agent Angus MacGyver, played by a spectacularly mulleted Richard Dean Anderson.The show's central gimmick was Agent MacGyver's extraordinary ability to improvise clever mechanical solutions to life-and-death crises-spur-of-the-moment fixes that often relied on duct tape or a Swiss Army knife.Whether he was bypassing a blown fuse with foil from a chewing gum wrapper, using baked potatoes as projectile weapons, or, less plausibly, enlivening a casket with an outboard motor, MacGyver was never dull.As a testament to how MacGyver's capacity for seemingly impossible kludges became part of popular culture, Saturday Night Live ran a series of "MacGruber" parody sketches, which later morphed into a full-length, fully forgettable feature film.Television presenters continue to mention "MacGyverisms" more than 20 years after the series' cancellation, and MacGyver's brainchildren are still put to the test on the popular science program MythBusters.My own first consciously MacGyveresque moment was prompted by an automotive crisis along Michigan's Route 131 during my impoverished student days, when the original episodes were still airing.An overheated Volkswagen led me to try a trick I'd heard discussed by Click and Clack on National Public Radio's Car Talk: patching a leaking radiator by cracking an egg into it.(The egg boils, the white congeals, and the gloopy mess seals the leak.)The egg trick is a temporary solution, if it works at all-and it didn't for me.But thinking of this incident led me to wonder what MacGyver might be able to teach busy doctors now.He might not have much to teach in the way of mechanical jerry-rigging, since a day in the clinic rarely requires clinicians to develop radiographic film with orange juice, or distract villainous prior authorization reviewers with a camera flash.But medical practice in this era of dysfunctional or failed systems-when institutions assume physicians have unlimited time to perform clerical and administrative tasks, pharmaceutical firms charge prices for new drugs that resemble Scott Boras-negotiated athletic contracts, and insurance companies seem to constantly push the bounds of what they can get away with-demands versatility and creative solutions.Clinical practice in the United States in the 21st century has become a long row to hoe.If ever there was an unstable edifice requiring MacGyver-like creativity to prop it up, caring for sick patients today is just such a wobbly structure.Although leatherman multitools may be in short supply in clinic workrooms, MacGyverish behavior is not difficult to find.Frustration and desperation breed invention, and I am endlessly amazed by the ability of my colleagues to improvise practices that may not fit into a bureaucrat's tick box but are necessary to obtain appropriate care for patients who might benefit.Creative ICD-9 coding, using a drug for purposes for which it is effective but was not originally intended, or making sure scheduling personnel hear the magic combination of words to get a needy patient onto a consultation list or procedural calendar are daily necessities.Within the bounds of the law, we do what we need to do to provide good care for our patients.Clinicians may indulge in deep thinking and theorizing after-hours, but in the clinic and on the wards, we are usually forced to be pragmatists.