I fully agree.

We all tend to think in very reductionist ways.
Simplicity is prime.
Far reaching conclusions are drawn from simple correlations and presented as cause-effect relations.
Only tests/investigations, research  with positive effects, which conform a preconceived idea's are considered as good.
We don't like persons , or institutions which question things.
We don't like independent thinkers, who question all the pragmatic reductionalist believes.
We don't like to accept that despite our knowledge, science we meddle in chaotic systems. Be it society or a collection of cells, or a collection of chemical products in a cell.
In other words we never know all.

Physicians allways make decisions on the basis of very incomplete information and very incomplete knowledge. Under such conditions  'mistakes' are common. Even the best will make them. Physicians operate and make decisions on the spot. During each consultation many decisions are made which influence outcome in severe ways.

In the light of the above mentioned thoughts, it is understandable that simplicity pays off. Simple rules (allthough imperfect), simple outcomes (allthough imperfect)
It is understandable that we are judged by such simplistic rules. And sentenced, punished.

In my view this explains the focus on the result, the simplistic result. And the admosphere of blaming, fining.
And not much attention and consideration is put in the observation of interacting elements in a chaotic system. Under these conditions it is not one element where the cause or effect can be seen and blamed, but the system, the process.

We will learn much more from life when we accept more the chaotic aspects of all interacting systems and consequences derived from it.
We will learn much more the moment we doubt more and question the simple, simplistic rules applyed to the individual. And try to understand the chaotic system.

We need new paradigms.
(Small example: The present one that medicine must strive for long livety won't bring quality of life)

We need more independend thinkers.
We need more people trained in thinking.
We need more people trained as philosophers.
We need less well trained medical craftsmen.
We need more well trained medical thinkers.
We need more well trained physicians who know how to deal with problems in chaotic systems.

We, personaly and as a society,  need to accept the fact that because of all the chaotic systems medicine operates in and on, we, physicians, are like sjamans.
Mysterious masters for the problems of life and death and suffering and solace of mankind.

We need new paradigms.

Gerard



At 20:38 -0000 26-09-1998, George Myszka wrote:
>In article <[log in to unmask]>, Adrian
>Midgley <[log in to unmask]> writes
>>THere is a serious point to this which is that if we want to have
>>things that matter measured rather than things that don't matter but
>>are easy to measure and administrators feel they can understand then
>>there is nobody else qualified to actually sort out what the things
>>are, and how to record them or assess them or genrally deal with them.
>
>Agreed. We need a new paradigm. One that moves away from monocausal
>events, but we are often our own worst enemies. Easy example -
>complained the gov didn't come clean about rationing then Dobbo _did_
>and so we complained about that! Sometimes we can't see the wood for the
>trees. All we had to do was back him up and only then enter into the
>argument about what is and is not rationed. We know that patient
>satisfaction as a measure of clinical quality is nonsense but which
>medical fool advised him to institute the survey?
>
>I wrote a lot more here but have deleted it. I cannot answer your
>question at this stage but APPLAUD your point. A start would be not to
>publish 'me-too' papers but actively seek out new ideas even though
>they're not 'RCT' or reviews. While we only move the goal posts with
>most medicine, we have to ask what we really want for outcome. We go on
>ad nauseam about patient centredness then only publish reductionist
>findings. One thing that we do need is this atmosphere of blame
>removing, so that mistakes can be examined and rectified rather than
>punished. <delete, delete>
>
>Regards
>
>George


ProRec- Nederland
Gerard Freriks,huisarts, MD
C. Sterrenburgstr 54
3151JG Hoek van Holland
the Netherlands
Telephone: (+31) (0)174-384296/ Fax: -386249
Mobile   : (+31) (0)6-54792800
ARS LONGA, VITA BREVIS




%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%