In my last two blogs, I wrote about the idea that much of the field of medicine hides behind a mask of science. I presented a very brief and minimal set of examples supporting my impression. And I promised to talk about some solutions.
First, a relatively easy solution. The vast majority of health care professionals (HCP's) care about their patient's and want to do well by them. In their pursuit of post training knowledge they are misled by a never-ending stream of data, a significant degree of it false or inaccurate, produced under the banner of science, by prevailing socio-economically driven forces, such as pharmaceutical companies. Eventually, after decades, the false claims are exposed. Why not have a required course detailing the many blind alleys medicine has traveled over the centuries? Why not educate HCP's to be real skeptics, grounded in fundamental principles of basic science and health, to be wary of trends, while being open to science? I think it would help. Those who are blind to history are bound to repeat it.
Now comes a more difficult part. As I write this, I find myself wondering: What is it that about the process of medicine and science that confounds the data, that blinds HCP's? Let's look briefly some factors that are operative in the process of becoming and being a HCP.
First, there is hope. When one enters a helping medical profession, there is the hope of helping people. If one is hoping to help people, one must engage in the search for answers. Hence, one expects lifelong training, a continuous process of learning.
Next comes frustration. As soon as one enters the clinical realm, one experiences frustration. When a HCP tries to help someone but fails, she either simply lets go ("Sorry Ms. Jone's, I can't help you"), or she looks for new answers or tools. Either way, the HCP must come to grips with frustration and not knowing.
Not knowing can lead to curiosity (and continued learning) or the third emotional factor, fear of uncertainty. HCP's generally fight very hard to master a paradigm, a way of thinking about illness and healing, in their training and practice. Despite failure in their ability to help many people, they are loath to question the fundamentally limiting nature of their paradigm. Questioning one's paradigm often causes increased anxiety due to uncertainty. HCP's love certainty (as do many people). They are drawn to the healing arts in part to reduce their own anxiety about illness and death.
Factors one to three (hope, frustration, and anxiety/fear) can, in theory, be dealt with via training, education about this aspect of being a health care provider, and more careful selection of the type of person that becomes an HCP. But here comes the toughest part: the hierarchical systems humankind sets up.
In the hierarchical system of capitalism, HCP's earn a living via their practice. In this country they are ensconced a very materially oriented culture. At least 400 years of American history (I recommend you read the book "Mad In America" by Robert Whitaker) demonstrates that the desire to exponentially increase one's ability to make money, by making profit from health related technologies or workers, is endemic to western societies. Just like you can't separate a bacteria's behavior from the terrain it inhabits, you can't separate this shadow side of medicine from the cultural terrain it inhabits. I suspect this dynamic applies to many types of societies. Feudalism, monarchy, socialism, communism, and capitalism are all, in practice, hierarchical systems. Some people always have more marbles than others, and every one aspires to have as many marbles as the next guy. And there is the rub. Materialism corrupts the practice of medicine. What is the solution? I owe the idea that follows to my colleague, Dr Morris, although I will take the ‘hit' for how wacky I might get.
First lets take a hard look at reality. In reality, every thing in life comes and goes. Money can be lost, but money can be regained. Health can be lost and regained. Relationships can be lost and regained. But there is one thing that can never be regained: time.
It only flows in one direction (unless you are a photon). Time is the final common denominator. Time is what makes us all equal. We are all subjects of Time.
What would happen if our currency were changed? What would happen if instead of dollars, we traded time units? Need a car? It costs 20,000 time units. To earn it, you would have to have put in 20,000 time units. You could have been sweeping streets or doing heart surgery. This idea would eliminate financial hierarchies. How would one account for the time involved in training an architect or a physician? The training could be debited from one's time account, and then paid back via time spent treating people. Frankly, this is one of the most challenging ideas I have ever come across, and thinking it through demands breaking out of the box that we are all a part of. But I like the idea, since it values all people in a similar manner. I am open to any ideas on how such as system could work. I do think it would clean up many of the harmful aspects of our society. What do you think?
