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November 16, 2018

Would You Rather?

The holidays are coming up and that could mean some travel time for you and your family.  If you happen to have young kids and a few hours of interstate driving in front of you, here’s an idea for you (I have been told that I have the humor of about a ten-year old boy, so this is my specialty):  Turn the screens off and play a little old-fashioned, ‘Would you rather?’

If you are unfamiliar with the game, it is easy, though having the aforementioned stunted sense of humor helps a lot.  One person simply asks everyone in the car the question with two horrible choices.  Here’s an example:

‘Would you rather drink a soda from Bobby Wilson’s nasty tennis shoe, or kiss Mrs. Gunther, the librarian who is so old that she might actually be a mummy?’

No weaseling out with a ‘Neither.’  And no trying to modify the options.  You have to pick one.

Yes, there is a small age window for which this game works.  I am apparently still in it.

This will seem like a completely abrupt pivot, but in his essay, ‘Why Doctors Hate Their Computers,’ Dr. Atul Gawande notes that medicine is a highly complex system, something comparable to a biological ecosystem, that requires sophisticated adaptation.

Adaptation is predicated on two things: mutation and selection.  Mutation – changes, innovations, experiments, improvements – creates deviation and more options.  It is what gives the system variety. Selection then comes along and kills off the bad ideas, allowing the good ones to flourish and gain traction.

Medicine has long played a bad game of ‘would you rather?’  For years, we were all mutation and no selection.  Individual actors – physicians, hospitals – all did their own thing.  We got a lot of variety, but too many bad ideas were allowed to persist for too long.  There was no efficient method for shutting them off.

Then along came the HITECH Act with its big subsidies and government mandates and we flipped the scrip.  Now we are all selection but have no mutation.  Both the federal rules and the inherent nature of massive computer systems attempting to serve the needs of too many constituents make small improvements difficult; real innovation is impossible.  These things now are, to use Gawande’s word, ‘brittle.’ 

Some overall improvements are being realized as the current ‘all selection’ mode snuffs out certain egregious bad practices.  But overall, innovation and improvement – the necessary adaptations of a complex system – have, and will continue to, slow.  We won’t have enough variety on the front end of the adaptation process. 

Brittle does not do change well. 

In ‘would you rather,’ both options are gross.

Tim Coan
Tim Coan

CEO and founder

Tim Coan, ALN’s CEO, writes an insightful and witty blog weekly about a variety of topics relevant to independent physician practices.