“Why do some innovations spread so swiftly and others so slowly?”
With his tale of two medical miracles—surgical anesthesia and antiseptics—Gawande brings his question not just down to earth, but right into your bodily sensations. (Try to imagine what it was like to have a tooth pulled without any anesthesia. Or to undergo surgery when doctors believed that the discharge of pus after an operation was necessary to healing.)
Gawnade thinks through some of the possible explanations for why anesthesia caught on so quickly, while antiseptics took a long time. Was one more economical, or have a greater economic benefit? No. Was one more difficult to accomplish? No. Where Gawande lands is quite interesting and has implications well beyond medicine: anesthesia attacked pain, which was immediate and visible; antiseptics attacked germs, which are invisible and whose effects are not immediate. He goes on, “although both made life better for patients, only one made life better for doctors. Anesthesia changed surgery from a brutal, time-pressured assault on a shrieking patient to a quiet, considered procedure… by contrast [antiseptics] required the operator to work in a shower of carbolic acid.”
Gawande sees this as a pattern of many important ideas and innovations that get “stalled”: “They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. …requiring individual sacrifice of one kind or another.”
This is the framework for the rest of the essay on how he and others have been working to spread safer childbirth practices in India—practices that have been known to work for well over a century but have been either unknown or known but resisted in India and other poor countries. Especially fascinating is the story Gawande tells of discovering and then trying to eliminate hypothermia as a leading cause of illness and death in newborns. The remedy is such a simple thing—placing the newborn on the mother so that her body can regulate the baby’s body temperature. What it took to begin to accomplish this may surprise you.
It wasn’t legislation. It wasn’t education. It wasn’t public relations. It was person-to-person relations. Talking to people. Slow, sustained, supportive. Conversations, not evaluations. Discoveries (“I really can do this and it really works”), not prescriptions (“Do this or else”).
I found Gawande’s stories and the entire essay very helpful in seeing the work I and many others are doing as part of the making of a conceptual revolution, that is to say, creating and spreading new understandings of what it is to be human, to work and play and live and love, and to make the world a better place for all.
For, the conceptual revolution is all about “slow ideas.” Human development as a life-long “becoming” social activity, performing and playing to create ourselves, non-diagnostic co-creative therapy, education that brings development and learning back together, the power of groups and “wisdom of crowds”—these are big ideas, but invisible to most people. They require sacrificing the legitimacy of the institutionally designated “best- (becoming “only” in some professions) practices.” I’ve been talking to people about them for years. Maybe you have to.