Craniorectal syndrome describes a symptom complex that includes:

1. Putting one’s head in places where the sun don’t shine

2. Ignoring the realities and impact of change

3. A overwhelming, and sometimes incapacitating, sense of denial and anger

4. Complacency

5. Sticking with the same game plan and lineup despite years of losing seasons

EPIDEMIOLOGY

While the incidence and prevalence of the disease is unknown, it seems to affect males and females in the same ratio. Research suggests , but has not proven, that the disease is more common in those over age 60. Workers in some industries appear to be more affected than others e.g. government, healthcare and higher education.

ETIOLOGY

The cause of craniorectal syndrome is unknown. Theories include metabolic, infectious and psychosocial abnormalities that result from environmental stimuli. There is no proven genetic basis but early childhood upbringing and behavior patterns seem to be predictive.

DIAGNOSIS

There are no lab or imaging tests that can confirm the diagnosis. Instead, the diagnosis is made clinically by observing behavior and how the sufferers deal with the consequences. There is a spectrum of disease. While no staging system has been widely adopted, symptoms range from mild to moderate to severe.

Stage 1: Some effort to spend time on environmental awareness and response (the new), while, at the same time, focusing on operational effectiveness ( the now) and efforts to expand products and markets (the next)

Stage 2: Paying lip service to innovation, but basically ignoring it and dabbling in new product development, most of which will fail. Signs include practicing innovation theater, hiring a Chief Innovation Officer, new signs promoting the company vision and mission on the wall and calling removing the wall clocks to avoid having to reset them on daylight savings time an innovation initiative.

Stage 3: A sole focus on short term, quarter to quarter numbers ignoring dropping ratings and market share.

Abnormal physical findings are rare although, in extreme cases, the cranium is located in some strange places.

TREATMENT

Treatment modalities include:

Pharmacotherapy. Mind altering drugs, including marijuana, have been shown to be effective in some cases. Pharmacogenomic determinants might predict outcome.

Cognitive behavioral therapy. Therapy is designed to alter negative thought patterns that trigger abnormal responses and behaviors that cause psychosocial harm.

Surgery. While indicated in rare circumstances, physically removing a patient’s cranium from their rectum is sometimes indicated when other therapies fail. Office based surgery with minimal sedation is equally as effective as surgery under general anesthesia.

Physical therapy. There have been isolated case reports of success using a brisk slap in the face.

Shock therapy These include misguided stock buy-backs or promoting people to higher levels of incompetence.

Palliative care includes:

1. Hiring Chief Innovation and Strategy officers
2. Creating Innovation Centers
3. Financializing the entity
4. Engaging in fraudulent billing practices
5. Consolidating
6. Selling to private equity
7. Retreating to the ivory tower
8. Using patients as loss leaders so you can sell their data
9. Eating your young
10. Marketing

Craniorectal syndrome appears to be increasing in endemic proportions. Clinicians should be aware of this trend and increase their diagnostic awareness. Unfortunately, there is as yet no ICD-10 code for craniorectal syndrome nor a CPT code for treatment, although a consortium of medical societies have formed a task force to lobby the AMA for a code designation. Here is the one you should use in the meantime.

Medicare and Medicaid routinely deny payment. Private insurance coverage for treating craniorectal syndrome is virtually non-existent because it is still deemed to be experimental and yet to be proven to be cost-effective.