Why'd You Have To Go And Make Things So Complicated?

Church was cancelled today due to icy conditions at 7 AM that were fine by the time church starts at 11, but it gives me some time to write. I really enjoyed the book Complications and Doug's thoughts. I will just add my comments on the topics Doug put out there.

1. The uncertainty in medicine - I enjoyed how the book portrays doctors as human, whereas we often give them superhuman powers in our minds. As Peter points out, we also do this with General Authorities, and to a lesser degree, I also catch myself doing this with car mechanics, reality TV stars, and politicians.

Before the US went to war in Iraq, I supported the action under the assumption that President Bush knew something that I didn't, something top secret that he just couldn't share with me. Similarly, I often assume that General Authorities know more than I do or have seen something that I haven't and thus they have more power to be spiritual. I thought plumbers knew more than I do, too, that I could never change a sink, until it was pointed out to me that they don't have advanced degrees. They just have more experience and the right tools. It's empowering to realize that I have just as much power and ability to do all of these things, IF I apply myself to learn the relevant skills and use the right tools (or if I invite Glenn over to help me change the sink).

2. Autonomy, consent, and the role of the patient - I have very conflicting feelings on this point. I believe that, as described by Gawande and Doug, patients often make very poor decisions, and particularly at the end of life, a lot of resources are wasted. Survival at all costs is not necessarily best for the community or the patient. Unfortunately, the only solution to this seems to be the dreaded 'Death Panels'.

As I read this book, I often thought about how the roles of doctors and patients compare to the roles of parents and children. Children often don't realize how human their parents are and how much uncertainty there is in what we do. And children may often make poor decisions, but after a certain age all parents can do is offer advice. Right now, my children are so young that my word is the law, but eventually, I'll have to grant them their agency and allow them to make poor choices, even if it's a waste of resources.

3. Top performers and practicing - That really is a great quote. I think Malcolm Gladwell (who was quoted on the book jacket of my copy of Complications) says something similar in his more recent book, Outliers. I think both Gladwell and Gawande are lucid, interesting writers.

4. Learning on the job - There is a lot of learning on the job and uncertainty in my profession, too, but the big difference is that I don't have a direct impact on the life or death of another person. (I may have an indirect impact in the approval or disapproval of a medical device, but I don't have to face them directly.) There may be mistakes in the learning process, but I don't see how the medical profession could do it any other way.

Speaking of my profession, though, I was happy to see that Gawande's attempt to use Decision Analysis didn't work because I think it's a bunch of bunk. It makes the process of arbitrarily assigning probabilities to different events seem scientific, when it's not. My boss is trying to get the FDA to use Decision Analysis on a wide scale, and I'm avoiding the meetings and hoping the movement dies quickly. I do believe that statistics has and will continue to help improve medical decision making, just not though Decision Analysis.

5. Medical errors and liability suits - I keep reading in multiple books how poor the litigation system is in preventing doctors from making mistakes. The worst doctors don't have the most lawsuits, and the best doctors still make mistakes. In the book, "Nudge", the authors suggest that people should be able to waive their right to sue in order to get lower insurance premiums, but the courts and lawmakers for some reason don't think that people should be allowed to waive their rights to sue.

This is the issue that drives me the most crazy about the whole health care debate. If Democrats are truly serious about reducing the cost of health care, then putting a cap on the amount people can sue for seems like an easy way to start (the studies on this issue seem pretty unambiguous), but this issue hasn't even been part of the debate. It just makes me think that Democrats aren't really trying to help fix health care, that it's just politics as usual. (Note: On a broader note, I'm open to universal health care, though I'm skeptical of the government's ability to efficiently distribute health benefits.)

6. The man who couldn't stop eating - Doug says, "If a person is so desparate to change, can they not dig deeply and find the motivation to change themselves?" I guess I'm more sympathetic than Doug to those that are not self-disciplined. I have a compulsion to play games/waste time when I should be working on my unfinished PhD research. Having tried and failed to change myself multiple times, you begin to stop trusting yourself when you say things are going to be different this time. If there were a surgical option such that I could get myself to always do what I thought was right, I would seriously consider it. (Of course, that may be Satanic of me to want to force myself to do good.)

And like the blushing example he gave, sometimes what outsiders perceive as a need to be more mentally disciplined is something rooted in a physical problem. Maybe we weren't born messed up, but perhaps the learned behaviors in childhood become hard-wired. I agree that as a society we are fat and lazy, as Doug said, and admittedly, whenever I see a morbidly obese person (there's one at work) I shudder and think, "Get a grip, Man!" Still, on paper, I'm hesitant to judge anyone too harshly.

Again, thanks Doug for the good read. I look forward to hearing everyone's comments.