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An occasional collection of thoughts, musings and provocations on current health issues.*  by Roger Hughes, Executive Director - SLHI

Ride Out!

In this age of hyper-obsession with accountability and performance, I sometimes wonder if there will be jobs in the future that any sane person will want.

Consider teaching. Shackled in public school classrooms by the chains of AIMS and other standardized tests that purport to measure whether a child is educated to “compete” in the new hyper-century, teachers adopt prescribed standards and practice algorithms to prescribed content and process, are continually “upgraded” with professional development courses, and find their freedom to innovate and teach to the individual needs and interests of their students severely limited.

Increasing numbers of teachers say they are unhappy and unfulfilled in the new accountability regime, and are losing the professional autonomy and control that attracted them to the profession in the first place.

Some physicians say the same thing, especially those who remember a time when they actually spent time with patients, treated the “whole” person, and had the professional autonomy and discretion to make clinical decisions based on years of experience and the art of informed judgment and scientific knowledge.

They won’t go gently into the good night of “focused factories,” cookbook medicine, narrow subspecialties and armies of evaluators and regulators wielding best practice manuals and standard deviation scores.

“I used to love what I do,” a physician told me recently, “until the corporations and HMOs came in. We’re all just workers now.”

That sentiment is harsh, and it’s hardly universal, but it’s suggestive of wider trends at work in our culture.

The first of these trends is the growing dominance of the imperative of technology, which is always to find the most efficient and effective means toward a specified end. Those of us who still cling to the fiction of the whole person are forced to acknowledge the power and sweep of our tools that break everything down to its most minute component parts and then reassemble them in reproducible algorithms that extend predictable control over the desired output.

The second trend is the elimination of variability in favor of uniformity. Ironically, while science demonstrates the necessity of variability in biological and organic systems, the application of technology favors predictability and control over “natural” variety. Whether it’s a child who is acting out in class or a patient who presents a bewildering array of seemingly unrelated symptoms, our tools – tests, drugs, procedures – conspire to either eliminate the variation or bring it within comfortable control of the mean.

In one not-so-science fiction version of the future, we will all be perfect or we will all be average. What we will not be is different.

The third trend is more confounding, but it’s prevalent nonetheless. This is our myopic fixation on performance and insatiable quest for perfection. Why else are we endlessly counting, measuring, sorting, classifying or surveying something? To understand it? No, to improve on it.

In many instances, this is a healthy trend. Zero tolerance for surgical errors and airline system failures comes to mind, among other things. But when it comes to the breathtaking variability in human and organizational characteristics and performance – the “spice of life” that brings beauty and meaning to our existence – the quest for perfection is not so healthy. Aside from fueling unrealistic expectations and the inevitable disappointment that follows, it fosters separation of mind from body, being somewhere else to being in the here and now, and a sense of self that depends on competition with others and often capricious standards of performance for validation.

But these are trends after all, not immutable laws. Whether we are teachers, physicians or foundation executives, we still possess the freedom to think otherwise and act accordingly.

Gird yourself with hope and laughter, o’ sons and daughters of the revolution! Ride out to face the machine!

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