Medicine, a human endeavour
Just read the book “Complications – A surgeon’s notes on an imperfect science” by Atul Gawade. Largely speaking it is about the practice of medicine. Through tightly written stories, it sweeps away many of our preconceived notions of infallible doctors and western medicine. It is absolutely fantastic.
The conclusions I found most pertinent were:
1. Learning
Short bursts with a team who has work history together is better than learning over a spread out timeframe. This is regardless of the skill or intelligence of the person (or group) who is learning.
Learning throughout a career. 75% (or more) of the information and skills you learn in training (school) will be useless. New technology and better practices will inevitably affect you and if you do not continue to learn, you will lose out.
2. Specialization to perfection
The Shouldice hernia clinic in Toronto is the best place in the world to have a hernia operation. This is because that is all they do – hernias – and have thus nearly perfected the process. This treatment of medicine as an industrial process speaks volumes of the possibilities of perfection through repetition.
Anesthesiology has greatly reduced deaths by standardizing medical equipment and practices; removing human intervention and decision making from the process. This may sound undesirable, but in reality if frees up the doctors for more creative thinking. The field of anesthesiology automated their field (thanks to an engineer) much like the airline industry (which is continually improving their safety record).
3. Mental – Physical connection
Obesity and stomach stapling have become part of American culture. After people have their stomach stapled, they still want to eat junk food, but cannot due to physical limitations. After a year or so their actual desire for junk food disappears and they prefer healthy food. This change in appetite goes hand in hand with their loss of weight. The link is between the mental state and physical state is true for most diseases.
4. People want to be told what to do, relinquish responsibility
In a time of increasing awareness of medical diseases and access to information on the web, patients are have become part of the decision making process. Despite this gift, people still want to be told what treatment they should choose. This has more to do with wanting to give up responsibility than anything else. Should something go wrong, it was not their fault. See the book “Stumbling on Happiness”.
5. Cartesian Limitations
Western medicine is based on Cartesian thought – if we know the symptoms, we can find the physical cause, and thus the cure. It is also factored into decision analysis, particularly in business ventures. If I know the risks of decision x and the payoff of the same decision I can calculate the probability of making money. This has been applied to medicine, but it becomes very difficult very quickly. How much do you value a leg, an eye or a life?
Simple cause and effect is very difficult in medicine where so many factors are at play. According to the author of the book, despite the inventions and uses of MRI, CAT scans, and other tools, incorrect medical diagnosis has not decreased in the past 30 years. Scary.
6. Transparency
The ability to openly discuss mistakes and ways to avoid them is absolutely fundamental to improving a system. But because medical practice involves death and harm, this becomes exceedingly difficult to do with pariah lawyers and cautious insurance companies. Yet, it is inevitable, in some ways doctors need to be granted asylum and only prosecuted when a trend of error becomes apparant. Good doctors make mistakes – blame does no one good
Conclusion
Don’t get sick, if you do, trust few.
Favorite quotes from the book:
Talking about free trinkets and medical conferences (pens, pads, stress balls…), “You might think six-figure surgeons would be oblivious to this petty bribery. But you would be wrong.”
And another lesson from trade-shows, “At booths, let people play.”
Published on September 15, 2007Fire and Thunder
I love TED Talks because the people are so insanely passionate about what they are doing. As stated by Erin McKean, “The internet is made up of words and enthusiasm.”
And Keroac’s famous (unaltered) musing: “the only people that interest me are the mad ones, the ones who are mad to live, mad to talk, desirous of everything at the same time, the ones that never yawn or say a commonplace thing … but burn, burn, burn like roman candles across the night.”
Forget complacency, waiting in line or doing what you’re told. Burn baby burn.
Published on August 30, 2007Debates as they were
Intellectual debates (at least in North America), no longer resemble anything like this. Sound-bite interviews on the major networks make more time for the host than the guest.
The closest thing I see to the attached video are the debates on www.edge.org or posts with comments on 3 quarks daily. TED talks and Slate’s www.meaningoflife.tv offer interesting points of view, but are not interactive debates.
Anyways, I picked up Foucault’s ‘Histoire de la folie à l’âge classique” at a local bookstore. Despite my initial enthusiasm, French philosophy always seems magical on the bookshelf, daunting on the night-table and eventually heavy in the hands. I also think that Foucault is wrong regarding the basis of the judicial system and Chomsky is right (see clip Part II – linked on Youtube).
The brief mention of rising multi-nationals is noteworthy. Here’s to the dreamers:
Part II:
[youtube=http://www.youtube.com/watch?v=VXBfOxfmSDw]
Agreements with Natives in Canada and Australia
Natives.
The way we (Canada) treat (some of our) natives:
http://www.theglobeandmail.com/servlet/story/RTGAM.20070813.wnunavik13/BNStory/National/
And the Australians:
http://www.iht.com/articles/2007/08/22/news/outback.php
The Australians seem set on ‘telling’ the aborigines what is good and bad. Their hard handed approach smacks of colonialism and the white man’s burden to transfer our glorious way of life to the locals.
Canada, has made significant steps to transferring genuine authority to the natives in the hopes that they will slowly develop the skill set which is required for a civil society and self-governance. We have also started giving ‘one-time’ transfers of cash and ruling out future transfers; thus, forcing the natives to become self-reliant. This is the most logical and low-cost method of dealing with the natives in Canada.
Perhaps helping their communities enter the 21st century will absolve some of the crimes we committed.
Published on August 23, 2007The Insane Artist
Just saw the Bruce Nauman exhibit in Montreal.
Very cool stuff. I repeatedly fail to understand modern art. It seems to be the sane observing the insane artist with little hope of truly understanding their madness that created the ‘art’.
Can a doctor understand, or worse – cure – insanity? What do I understand of Nauman, Kerouac, Duchamp, Ginsberg, …. except that they existed over the edge and looked back at us.
That being said, Nauman’s work is definitely worth seeing and you should check out the exhibit before it closes.
