Sunday, July 29, 2012
Not all bad outcomes need to be addressed with fundamental changes
The problem is that in order to assign blame in any sort of functional way, one needs to understand actual causality and in order to understand causality, one needs to live in a world where one can predict events with some degree of accuracy. The world is not such a place. Granted, one can define a profile for who might commit such an act but there are tens of thousands if not hundreds of thousands (if not millions) of people who could be made to fit the profile. You can take about restricting access to the materials which are possibly dangerous and could be leveraged by such individuals. Again, such efforts can be undone by bright and perversely motivated human beings, of which there appears to be no shortage.
Similarly, when we observe spectacular bad outcomes, it may not be wise to respond based upon the assumption that the outcome is a result a something being fundamentally broken. The tragedy of such responses is that they often occur because our outrage as an immediate aftermath of the events creates the incentive to do something quickly, before we can possibly understand what happened. These responses are also predicated on the assumption that we must do something because we can't possibly make things worse or create new problems, an assumption which is often tragically wrong.
We have made such strides in the past two centuries regarding the improvement of human existence (although their deployments have been spotty) that we have developed a skewed view of the where we have come from and what expectations are possible. In the developed world, life expectancies have soared and yet, we act as though our world and life styles are vastly inferior to our ancestors who on average lived decades less than we do today. The almost universal response to any new "crisis", which occur on an almost daily basis, is that we need more rules, more laws, and a greater role for the state in forcing people and non-state entities to do things is an increasingly constrained way. This path is driven by the assumption that the world is perfectible, if only enough rules made by smart people could be put into place. There will never be a shortage of bad events which happen which can serve as a constant driver of this trend. It can and should be resisted.
In the same way that bad outcomes in the non-health care realm drive the adoption of new practices and rules, a similar set of events tend to play out in medicine. A single patient who develops a bad outcome after presenting with a non-specific complaint may result in wholesale changes in how patients are managed. This may result in huge changes in how scarce resources are allocated, which tests are done, and which treatments are deployed. Similar to the responses described above to natural and financial calamities, all of this is predicated on the assumption that more is always better and interventions, which may turn out to be useless, can be deployed at zero cost and without unintended consequences.
As people spend more and more money in the health care realm, we within the health care industry have a vested interest in promoting our crafts as being very powerful and impactful. It is very difficult to respond to the public when bad things happen with the message that events are beyond our control, even if that were the case and we were wiling to admit it. Such admissions may prompt the public to invest their resources in other realms where they perceive a better rate of return. That potentially would be unwise, unless in fact the public's investments in other things actually yielded better returns than an investment in health care. Perish the thought.