Not one stakeholder group left untrashed…<\/p>\n
Great Einstein quote – the original definition of insanity presumably:<\/p>\n
\u2018The significant problems\u00a0we face cannot be solved at the same level of\u00a0thinking we were at when we created them\u2019<\/p>\n
PDF:\u00a0<\/span>Braithwaite Delusions of health care JRSM 2014<\/a><\/p>\n The medical miracles delusion<\/strong><\/p>\n Army ants subscribe to a simple rule: follow the ant Only half of care delivered is in line with guidelines,5 take up than imagined and comparatively little Not one stakeholder group left untrashed… Great Einstein quote – the original definition of insanity presumably: \u2018The significant problems\u00a0we face cannot be solved at the same level of\u00a0thinking we were at when we created them\u2019 PDF:\u00a0Braithwaite Delusions of health care JRSM 2014 The medical miracles delusion Army ants subscribe to a simple rule: follow the … Continue reading A clear head shot from Jeffrey…<\/span>
\nin front. If the group gets lost each ant tracks
\nanother, eventually forming a circle. According to
\ncrowd theorist James Surowiecki, one circle 400m
\nin circumference marched for two days until they
\nall died.1
\nHumans are not ants, but we often trudge together
\nalong the same trail, neglecting to look around for
\nalternatives. Mass delusions involve large groups
\nholding false or exaggerated beliefs for sustained periods.
\nHumanity has a long, sorry list of these shadowthe-
\nleader epidemics of collective consciousness which
\nappear obviously wrong only in hindsight. Some last
\nfor centuries: early alchemists intent on transmuting
\nbase metals into gold and the Christian Crusades of
\nEurope\u2019s middle ages, for example. Others have correlates
\nwhich resurface decades or centuries later:
\nMcCarthy\u2019s persecution of alleged communists in
\nthe 1950s harked back to the Salem Witch hunts of
\n16th century America just as the 2008 Global
\nFinancial Crisis had much in common with the
\n\u2018South Sea Bubble\u2019 which slashed 17th century
\nBritain\u2019s GDP.
\nIn the educated 21st century, too, we blithely trust
\nin economic and political systems which are stripping
\nthe earth\u2019s resources, altering the climate and facilitating
\nwars. Are we then similarly mistaken, en masse,
\nabout the capabilities of the health system?
\nMost of us believe in the miracles of modern medicine.
\nWe like to think that the health system is
\nincreasingly effective, that we are implementing
\nbetter treatments and cures with rapid diffusion of
\nnew practices and pharmaceuticals and that there is
\nalways another scientific or technological breakthrough
\njust around the corner promising to save
\neven more lives; all at an affordable price.
\nWe maintain the faith despite multiple contraindications.
\nModern health systems consistently deliver
\nat least 10% iatrogenic harm.2 Despite very large
\ninvestments and intermittent but important interventional
\nsuccesses, such as checklists in theatres3 and
\nclinical bundles in ICU,4 there is no study showing
\na step-change reduction in this rate, systems-wide.<\/p>\n
\none-third is thought to be waste,6 and much is not
\nevidence-based,7 notwithstanding concerted efforts to
\noptimise that evidence and incorporate it into routine
\npractice.8
\nThe reality is that progress is slowing, and medicine
\nseems to be reaching the limits of its capacities.
\nThe potentially disastrous problems of antibiotic
\nresistance, for example, are yet to play out. This is
\nonly one point among many. New technologies such
\nas the enormously expensive human genome project
\nhave provided only marginal benefits to date. We still
\ndo not have the answers to fundamental questions
\nabout the causes of common diseases and how to
\ncure them. Many doctors are dissatisfied and increasingly
\npessimistic.9,10 It must also be remembered that
\nalthough death is no longer seen as natural in the
\nmodern era, everyone must die. Yet, we inflict most
\nof our medical \u2018miracles\u2019 on people during their last
\nsix months of life. Le Fanu describes this levelling off
\nand now falling away of health care progress in The
\nRise and Fall of Modern Medicine.11
\nEvery major group of stakeholders has its own
\nspecific delusion which acts to augment the metalevel
\nmedical miracles delusion. Thus, the overarching
\ndelusion is buttressed by a set of related \u2018viruses
\nof the mind\u2019, to borrow Richard Dawkins\u2019 evocative
\nphrase.12
\nAlthough politicians think and act as if they are
\nrunning things, modern health systems are so complex
\nand encompass so many competing interests that no
\none is actually in charge. Then, bureaucrats \u2013 acting
\nunder their own brand of \u2018groupthink\u2019 \u2013 assume their
\nrules and pronouncements provide top-down stimulus
\nfor medical progress and improved clinical performance
\non the ground. Yet coalface clinicians are relatively
\nautonomous agents, so there can only ever be
\nmodest policy trickle down.13,14
\nResearchers, too, support the medical miracles
\nindustrial complex. The electronic database
\nPubMed holds some 23 million articles and is growing
\nrapidly. Every author hopes it will be his or her
\nresults that will make a difference, yet there is far less<\/p>\n
\ninvestment in the science of implementation8 \u2013 translating
\nevidence into real life enhancements.
\nNor are clinicians or the patients they serve
\nimmune. While frontline clinicians strive to provide
\ngood care, many myopically assume their practice is
\nabove average; the so-called Dunning-Kruger
\neffect.15,16 Of course, statistically, half of all care clinicians
\nprovide is below average. And notwithstanding
\ndecades of public awareness, patients believe modern
\nmedicine can repair them after decades of alcohol,
\ndrugs, sedentary lives and dietary-excesses, despite
\nevidence to the contrary.
\nMeanwhile, the media\u2019s unremitting propensity to
\nlend credibility to controversial views and to hone in
\non \u2018gee whiz\u2019 breakthroughs \u2013 while ignoring the
\nincremental and the routine \u2013 fuels unrealistic expectations
\nof what modern medicine can deliver.
\nThroughout history, mass delusions have been
\naligned with mass desires for favourable outcomes.
\nIn the pursuit of medical miracles all of our interests
\nline up in a perfect circle. We seem more like army
\nants than we think.
\nJust as the Global Financial Crisis was a wake-up
\ncall for the serious consequences of blind fiscal faith
\nwe must begin to manage our expectations of the
\nhealth system. Progress is always in jeopardy when
\nthe real problems are obscured.
\nThe challenge is to harness the tough-minded
\nscepticism needed to tackle this widely held \u2018received
\nwisdom\u2019. One realistic way forward is to encourage
\nstakeholders \u2013 politicians, policymakers, journalists,
\nresearchers, clinicians, patients \u2013 to first consider
\nthat their own and others\u2019 perspectives are simply not
\nlogically sustainable. This may be achieved through
\ngenuine inter-group discourse about the health
\nsystem, where it is at, and its limitations.
\nAs is so often the case, Albert Einstein said it best,
\nin a typically neat aphorism: \u2018The significant problems
\nwe face cannot be solved at the same level of
\nthinking we were at when we created them\u2019.17 If we
\ncan humbly accept that we need new perspectives
\nfor healthcare \u2013 and radically different ways of
\nthinking \u2013 we will be better placed to free ourselves
\nfrom the hold of these peculiar viruses of the mind.<\/p>\n","protected":false},"excerpt":{"rendered":"