Memo From The Editor

Paradoxes

Marianne Dekker Mattera

Someone sent me an e-mail the other day that purported to be an essay by George Carlin. As is often the way with e-mails, I can't be sure it's what it claims to be, but the message was apt. It pointed out many of the huge paradoxes of our time. Some of them dealt with medicine in the modern world:

"We have . . . more medicine, but less wellness. . . . We've learned how to make a living, but not a life. We've added years to life, not life to years. We write more, but learn less. We plan more, but accomplish less. We've learned to rush, but not to wait. We build more computers to hold more information . . . but we communicate less and less. . . . These are days of overweight bodies, and pills that do everything from cheer, to quiet, to kill."

I came across another health care paradox in a much weightier document, a paper entitled "RVUs Blues: How Should Docs Get Paid?" published in the May-June issue of the Hastings Center Report. The author, John Lantos, explores the fact that it's become increasingly difficult to place a value on the work that doctors do. "In this world," he notes, "doctors' pay is based on their precisely quantifiable skills and techniques, rather than their more-vague attitudes, habits, or virtues." But it's those vague attributes—the caring, the compassion, the things doctors do after they've performed the billable service—that define what it is to be a doctor. The more definable a skill, the easier it is to train a tech to do it.

"To the extent that medicine becomes defined by such measurable skills and by the production of measurable outcomes . . . it becomes less than we need it to be," says Lantos. "Medicine becomes all that it can be . . . only to the extent that we resist the forces that discredit the unquantifiable and so, perhaps, relieve just some of the suffering that knows no measure."

What do you do about these paradoxes you must live with every day? Besides grumble and get depressed? You can support efforts by organized medicine to force the government and insurers to put greater value on the unquantifiable in medicine—the art, if you will. Beyond that, there may be little you can do except change your own mindset, keeping before you what it is you wanted to be when you went into medicine, and acting on it.

The e-mail offered suggestions for living with all the paradoxes we find in this world:

"Remember, spend some time with your loved ones, because they are not going to be around forever. Remember, say a kind word to someone who looks up to you in awe. . . . Remember to give a warm hug to the one next to you, because that is the only treasure you can give with your heart. . . . Give time to love, give time to speak, and give time to share the precious thoughts in your mind."

And doesn't that define what a doctor does?

 

Marianne Mattera. Memo from the Editor: Paradoxes. Medical Economics Aug. 8, 2003;80:9.