CME Noir: Accreditation With Condemnation (Chapter 1)

So…I’ve written a short story about a CME detective named Jake Powers. Or rather, the first chapter of a short story about a CME detective named Jake Powers. Right now, you might be thinking, “Why? Why would you bother to do this?” Fair question, to which I respond: I…don’t know. Because I thought it would be amusing, I guess. I am a sucker for a good detective or spy novel and have always wanted to try my hand at writing one, but I have nowhere near the writing skills to do it well. At the very least, I was able to entertain myself for the few hours I spent writing it. I can guarantee you one thing: this will be the best piece of CME noir writing you read today!

To be clear, this is intended to be tongue-in-cheek. It’s supposed to be ridiculous. No characters or organizations mentioned in this story are real, nor are they intended to be representations of real-life individuals, blah, blah, blah. It’s a story. It’s fiction. It’s about a CME detective, for Pete’s sake! (However, if you do happen to know a real CME detective, let me know. I would love to meet him/her!)


Chapter 1: Trouble Never Knocks

The pellets of rain on my office window beat a symphonic tattoo that soothes my alcohol-soaked brain. I pour another cup of night-black coffee in my stained styrofoam cup and tell myself the generous splash of bourbon I add is to take the edge off the caffeine, but I’ve been lying to myself for years. This is how I make it through my days and nights in a world where manufactured truth is fact, fact is king, and the king is dying. My name is Powers. Jake Powers. I’m a CME detective.

I recline back in the ancient wooden office chair, prop my scuffed loafers on the gun-metal gray desk, and take another contemplative sip of the smoking hot java. Extending from the rolled-up sleeve of my wrinkled white oxford, my left hand holds the latest case to cross my path. Having already memorized its contents, I barely look at it as I gaze out the window and consider my next steps. Elton General Hospital—a small regional hospital a couple blocks away—had contacted me about a problem. A CME problem. Of course. That’s why people come to me. They have problems: I fix them.

Poor Elton General had got themselves into a bit of a bind. It seems as though some wet-behind-the-ears resident in the Family Medicine department had—in an effort to impress his attendings—had Daddy call in a favor with one of his golfing buddies to lecture at an upcoming grand rounds. It just so happened that Daddy’s golfing buddy was renowned physician, lecturer, philanderer, and (sadly for Elton General’s CME department) professional pain-in-the-keister, Nigel Halloway. And while Dr. Halloway may be a speaker of the finest sort, he simply could not be bothered to do something as petty as complete a few forms, especially of the sort required by that ghastly CME department (“The very nerve of you,” the petulant doctor snarled over the phone to the 22-year old temp worker Elton General CME employed to pursue missing paperwork, “asking me to publicly disclose my private financial matters for all to see! You’ll sooner see me tee off on the 12th at Merion with a 1-iron before you’ll see my signature on one of your dreadful little forms!”)

Dr. Halloway’s stubborn refusal to complete a standard Conflict of Interest form, even with his scheduled presentation date a scant few days away, was causing great distress to all involved. Having already bragged to his colleagues about Daddy’s connection to the great Dr. Halloway, the new resident was on the verge of a nervous breakdown at the thought of the ridicule he would face—not to mention Daddy’s embarrassment—should the presentation be cancelled. In turn, his constant phone calls to the Elton General CME department to inquire about Dr. Halloway’s status were beginning to border on harassment. At wit’s end, they finally called me. They always do.

I took another long slurp of coffee and reached for the dusty black rotary phone located on the upper right corner of the desk. Lifting up its hollow body, I scooped out the disposable cellphone I keep around for phone calls of an…unpleasant…nature. It was time for the good doctor and I to have a chat.

“Goooood morning, Dr. Halloway’s office, this is Dorothy speaking, howmayIhelpyou?” chimed the perky voice with the slight Southern drawl on the other end of the line.

“I’m sorry to bother you this morning, Dorothy, but I’m in need of a little assistance.”

“Well, just tell me what assistance you need and I’ll see what I can do, Mr…?”

“Powers. Jake Powers.”

“Well, Mr. Powers, just what is it you need help with today, hmm?”

“Dorothy, what I really need is to talk to Dr. Nigel Halloway, but I’m willing to bet a bottle of Johnnie Walker Blue that if I tell you that, you’ll tell me he’s busy seeing patients and you’d be happy as pie to take a message. Do I have that about right?”

“Well Mr. Powers, Dr. Halloway is quite busy and-”

“That’s quite all right, Dorothy. I just have a brief message for my dear friend, Nigel.”

“Well, Mr. Powers, I’ve got my pad and paper, go right ahead.”

“Please let Dr. Halloway know that Senator Herb Lawnley and I have a standing Friday morning tee time at Pine Valley and we would love to have him join us this week. Also, please let him know that his good friends at the Elton General CME department say hello.”

“OK…Senator Lawnley…Friday morning at Pine Valley…Elton General…got it! Is there a number he can reach you at Mr. Powers?”

“Actually, Dorothy, I’m going to go ahead and suggest that you might want to give ol’ Nigel that message while I’m still on the line.”

“Oh…well…as I said Mr.-…”

“Trust me, Dorothy, it’s for the best.”


“It’s just that Pine Valley is quite spectacular this time of year and Senator Lawnley is most anxious to meet the doctor. Be sure to tell Nigel that. I’m sure he would be disappointed to miss such an opportunity due to a late arriving message.”

A long sigh from Dorothy.

“Please hold, Mr. Powers.”

Senator Herb Lawnley has been making national headlines over his campaign to clean up what he considers to be a corrupt CME industry. His particular focus of late has been targeting nationally-known, so-called “Key Opinion Leaders”, who make a pretty-penny touring the CME lecture circuit. He demands extensive documentation pertaining to where they’ve lectured, what they’ve spoken on, who funded the program, how much honorarium they received, and who else’s payroll they’re on. So far, several high profile physician lecturers have received the ominous “Lawnley Letter” demanding this information, and the outrage over the time sink involved in providing the requested details has been great. To make matters worse, no response has yet been offered from Senator Lawnley’s office as to their findings—only insinuations that more “Lawnley Letters” would be forthcoming.

The beauty of all this is that I really do have a standing tee time with Herb Lawnley, or “Hoots” as he was known back when we were roommates freshman year at Elizabethtown College. Our first weekend on campus, Hoots talked our way out of a little brush with the local authorities and I introduced him to the wonders of the single-malt. We’ve been friends ever since.

The smooth jazz muzak suddenly cut out as Dorothy came back on the line.

“Mr. Powers?” Dorothy said with a hint of confusion in her voice. “Yes, Dr. Halloway said that the papers would be sent over in the next 15 minutes. I’m not sure I know what that means, do you?”

“Yes, Dorothy, I do. You’ve been very accommodating, Dorothy. I do appreciate your assistance. Oh, and Dorothy?”

“Yes, Mr. Powers?”

“You might as well go ahead and cancel the rest of Dr. Halloway’s patients for the rest of the day. I believe he might be coming down with a touch of something serious.”

“Well, yes, he did look a bit pale when I was talking to him, but how could you possibly know that?”

“That’s my job, Dorothy. Take care, now.”

With a satisfied smirk, I powered off the phone and returned it to its hiding place. I barely had time to take another sip of the now lukewarm coffee, before a shadow fell across the frosted glass of my office door, the door swung open, and in strolled trouble.

Frederick Jefferson Heatherington, III was immaculate in a faintly pinstriped jet-black suit with lavender paisley tie and matching pocket square peeping out from his breast pocket. His wing-tips were shined to a gleam that matched his excessively oiled hair, which—even though he was just a shade short of sixty—remained as black as his suit.

“Door’s open!” I deadpanned as Heatherington closed the door behind him. “Fred! Just…spectacular to see you at this time in the morning. Still coloring the hair, I see.”

“Mr. Powers, a pleasure as always,” Heatherington purred smoothly. He glanced around the cramped office with the look of someone who just stepped in a pile of fresh dog poop. “I must say, Powers, I do like what you’ve done with the place. It suits you perfectly!”

“Thanks, Fred, make yourself at home.”

I motioned to a chair in front of the desk, crammed with old files, while grinning inwardly at the twitchy eye Heatherington developed every time I used the detested shortening of his first name.

“Quite all right, old boy, I much prefer to stand whenever I’m dealing with matters of business, don’t you agree?”

“Whatever,” I sighed.

I reached for my coffee cup and propped my feet up on the desk, scattering a few papers as I did so.

“Whaddya want, Fred?”

“Indeed. That’s what I like about you, Powers, always right on tack. To business, then!”

I rolled my eyes, pulled an audio recorder from my shirt pocket, clicked “Record”, and tossed it on the desktop.

Heatherington glanced at the recorder, raised his right eyebrow, then broke into that Cheshire cat grin made famous as the symbol of Heatherington CME, Inc.

“Really, Powers, I’m a bit put out by all this. Am I not among friends? I don’t mind telling you the information I am about to divulge is of a rather sensitive nature. Surely you can put away that little toy of yours for a few minutes?”

I rolled my eyes again, snapped off the recorder and tossed it on a stack of papers.

“Anything for you, Fred,” I grumbled. “Feel free to speak openly.”

Heatherington nodded in appreciation while my iPhone—hidden behind the same mound of papers on which I tossed the recorder—sprang to life. I had turned it on when Heatherington first walked in and it was now responding to my words “speak openly”, for which upon hearing, it was programmed to automatically start the voice recorder.

“Right, then. May I be perfectly frank with you, Powers?”

“That’s generally what “speak openly” means, yes.”

“Too right, of course.” Heatherington finally gave in and perched himself on the arm of the crowded chair.

“I am a man of business. This comes as no surprise to you, Powers, I’m quite sure.” He frowned a bit, adjusted his tie, and continued. “My goal in this business is to make money. This has never been in doubt and I have never claimed otherwise. And—if I might buff my own bumper a bit—I have been quite successful at doing so.”

Heatherington, for once, was being modest. It was well known that Heatherington CME was far and away the most financially successful medical education company around and it wasn’t even close. The last time I ran into Heatherington was in the hotel bar at the San Francisco Marriott during the last Alliance for CME conference. Three fingers of Laphroaig and he was babbling on and on about the $30 million, 30% profit margin Heatherington CME had achieved the past year, which was DOWN from the year previous. The diamond-rimmed Rolex peeking out from under the Armani suit sleeve was no fake.

He went on.

“CME has been good to me these past 30 years. I’ve had a good life and when it comes right down to it, that’s what it’s all about. Yet-“

Here I interrupted before he could go on.

“That’s interesting, Fred,” I drawled, lacing my fingers behind my head. “Here I though CME was all about educating docs and improving patient care.”

“Pish-posh!” Heatherington sneered with the disgusted look of a man realizing his bottle of Domaine Leflaive Bienvenues-Bâtard-Montrachet was a ’73, not a ‘72. “Don’t tell me you buy that barrel full of bunk the so-called “leaders” of this industry wheel out every time they think someone might be listening. It’s about the money and you, sir, are well aware of that, although judging by that jacket on the back of your chair, perhaps you don’t.

I didn’t give him the satisfaction of a response, only adjusted my feet on the desk and yawned.

“OK, Fred, seriously this time. What…do you…want?”

Heatherington looked me straight in the eye and cracked that Chesire smile, again.

“I want you, my good man, to dig up what your types refer to as “dirt”, on the golden boys of the moment, Kaleidoscope Learning Institue.”

That got my attention.

“No,” I replied without hesitation.

Heatherington, still grinning, looked at me and slowly blinked.

“Whyever not?

“Why should I?” I answered, taking my feet off the desk. “I have no beef with them. They’re trying something new and, as far as I can tell, it seems to be working. It’s hard to argue with their results.”

Kaleidoscope Learning Institute—or KLI—was made up of a group of ten CME veterans from varied backgrounds who had each grown disillusioned with the current CME industry. Five years ago they banded together to form their own CME organization that was built on a foundation of three core principles:

1) Education where education is needed
2) Target outcomes at Level 5-7 and publish results
3) No commercial support

Most in the CME community looked at them with a skeptical eye as they were starting out and few were surprised when they had to layoff most of their support staff after the first year. But after the second year, when every one of their CME projects had produced an outcomes paper published in a peer-reviewed journal, people started to take notice. By their fourth year, they had a staff of 25, had moved into a new office beside City Hall in Center City Philadelphia, and had been the subject of a cover story in Medical Meetings magazine (“KLI CME: Footloose and Commercial Support Free!”) And by all indications, they were doing it completely free of any type of commercial support and only occasionally charging a nominal fee for their programs. No one was quite sure how they were doing it.

The smile on Heatherington’s face began to fade a bit.

“See here, old boy, I’m not asking for your opinion then, am I? I’ve come to you with an important endeavor for which you claim to be qualified and I think it unwise of you to cause me irritation in the interim!”

“OK, now, don’t go gettin’ your knickers all in a bunch,” I soothed.

Heatherington’s frown deepened while I slurped the dregs from the bottom of my coffee cup, crumpled it, and tossed it in the vicinity of the dented trash can, missing his Bruno Magli’s by a fraction of an inch.

I started again.

“I’m not saying I won’t do it, but-”

“The devil, you didn’t!” Heatherington interrupted. “Not just but a moment ago you looked me flush in the face and said, and I quote, ‘No!'”

“OK, maybe I did,” I admitted.

Heatherington started to speak again but I raised a finger to quiet him.

“Look, Fred, you can’t just waltz in here unannounced, demand I poke around in the private affairs of the most high profile company in your field (He started to protest again, but I shot him a dirty look to quell his words.), and then stomp around in a huff when I seem reluctant. You’ve got to give me something to work with!”

For a third time, Heatherington started to talk and stopped. This time, a slow smile began to spread across his freshly-shaven jowls. Wagging his finger at me, his smile broadened.

“Bully good, Powers!” he boomed. “You certainly had me going there for a tick! Thought I’d stepped into the wrong CME detective’s office, I did!”

He stood from his perch on the chair, dumped its contents onto the ground, unbuttoned his coat, and sat, his smile growing even larger until it appeared he might burst.

“Dear Mr. Powers, I do believe I have something you can ‘work with’.”

With that, he reached into the inner pocket of his suit coat and pulled out a single sheet of paper neatly folded on a horizontal crease. He flipped the paper on my desk and settled back in his chair with an expression of pure amusement.

I swiveled around in my chair to the battered coffee pot by the smeared window. Locating another cup on top of my only filing cabinet, I poured myself another shot of caffeine. Turning back around to my desk, I grabbed Heatherington’s paper, and started to read.


15 responses to “CME Noir: Accreditation With Condemnation (Chapter 1)

  1. First we got a superhero (CME Hulk), and now we have our own noir CME detective–this business is looking up! Seriously brilliant stuff. More please.

    • Thanks, Sue! Considering I wrote the entire first chapter while riding my exercise bike, it might take a bit before I have chapter 2 ready to go. Either that, or I’m going to be in really great shape!

  2. Good story! More latent talents, eh Derek? Yeah, get into great shape and give us more chapters!

  3. Hah, just realized my comment could be insulting. Not meant to be!

  4. Excellent stuff Derek. Waiting with extreme anticipation for the next chapter! Such a work of fiction…… or is it? Shall we check your coffee cup?

  5. the 12 days of Christmas, some people

  6. don’t know what CME is

  7. Please continue this series. It is great fun reading it, and want to know what will happen with Frederick Jefferson Heatherington, III and Jake Powers. Will Jake actually take on the assignment and if so, did he find any dirt on Kaleidoscope Learning Institute?

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