Nature of Medicine Ignored – Why Programs Fail

David Suzuki made millions telling Canadians about The Nature of Things, starting with his show by the same name.

He mixed science with story-telling to promote everything from the environment to globalism.

His descriptions became prescriptive. He told us what is, and we inferred what ought to be. Regardless of what you think of Suzuki’s politics, his methods work.

Medicine needs its own Nature of Things. Doctors treat patients every day, while government works to redesign the healthcare system.

For example, Bill 41, the misnamed Patients First Act, redesigns medical care: a utopian overhaul. Government wrote Bill 41 without any input from doctors at large.

Politicians need our help, even if they are too busy or blind to see it. Political solutions need to fit the problems they aim to fix. Otherwise, solutions fit like square pegs in round holes.

Children eventually tire of pounding square pegs, but politicians tend to reach for bigger hammers and blame the round holes for not being properly square.

The Nature of Medicine

David Suzuki could not save whales, if he forgot how whales differ from seals. Politicians cannot fix medicare, if they forget how medical care differs from stir fry.

Government often ignores basic features of medical care. Things like:

Relationships

Doctor-patient relationships stand at the centre of medicine. This is axiomatic.

Relationships are exclusive, sacrificial and demanding. We will never solve problems of access, cost or equity without considering relationships first. For more on this, see: Relationship vs. Stewardship.

Organic 

Medical care is organic. It changes and develops depending on patient needs. Communities of care spring up to meet patient needs, long before bureaucrats dream up policies to attempt the same thing.

Communities of care change based on the life stages of the physicians involved: Illness, age and family dynamics change what a physician can offer.

Physicians are not little factories, even though they may look that way from parliament.  Medical care thrives on diversity, variety and pluralism, in the midst of an overall drive for best practice and excellence.

Autonomy-Ownership-Freedom

Especially now, society puts patient autonomy above almost every other moral principle.

Autonomy assumes freedom over one’s own body. It assumes that people own their body and should have control over what happens to it.

Autonomy, ownership and freedom weave through clinical care.  Patients are autonomous, free beings, not slaves.

By extension, physicians own clinics and maintain professional businesses. Physicians are independent contractors, not employees. Ownership and freedom apply to doctors, too.

Rational Self-Interest 

People seek help when they are sick, in the same way that they seek food when they are hungry.

Normal, ethical people seek what they need: care, food, shelter. Our society thrives on people working to improve their own lives, which improves the lives of those around them, for example, by inventing cellphones and sushi.

Incentives play a big role in behaviour.

Tradition 

Strange rituals shroud institutions, in which people share deep secrets and expose private parts to strangers.

Since Hippocrates, medicine has grown features developed over 3000 years. Within tradition, doctors celebrate curiosity and innovation as they try to solve patient problems.

Transcendence 

Clinical care starts with humans, not widgets. Patients are more than the sum of their parts.

Ignoring What’s Important

Medical care includes all this and much more. Too many government ideas ignore relationships and trample on autonomy.

Government overlooks self-interest, or creates misaligned incentives, and then acts surprised at the mess. Politicians dream up new traditions every election cycle, and then they call doctors obstructionist, for not changing more quickly.

Bureaucrats cannot see all the graceful, organic solutions that spring up around patient needs, every day. Efficient, centralized control has no measure or method to protect transcendence in clinical care, as a public good.

Doctors must learn to tell stories about the nature of medicine. Otherwise, well-meaning politicians will write policies, and draft laws, that destroy the nature of the thing they are trying to fix. And patients will suffer for it.

Photo credit: www.davidsuzuki.org