Monday, May 15, 2017

How Does This Matter?

Time away from the daily grind of practice has given me time to reflect. The results of that reflection are disquieting.


People are surprised when I tell them I enjoy working as a Coroner. My stock answer when asked why is normally a wisecrack: the patients don't talk back; I can't make the patient any sicker; and so on. The real reason I enjoy it - apart from some interesting cases - is that a death is, ironically, one of the few occasions in life when people no longer fret over what no longer matters. Taking just a moment to hit the proverbial pause button, to ponder the significance (or seeming insignificance) of a life, is calming. It fosters pensive reflection and "mindfulness", at least as I've come to understand it.

A doctor in my community died by suicide recently. It wasn't reported in the news, and I had only a passing familiarity with the deceased. I am, however, quite close with some of the late doctor's colleagues, and they have been uniformly devastated. Worse still, they've had no chance as a team to grieve. The need to pick up the pace, to shoulder the load of their dead co-worker, to serve the needs of the system, has overrun the real human needs of the people that make the system work. An insatiable beast now devours its own.

I'm reasonably active on social media. I'll happily engage in debate on any topic from alternate payment plans to zoonotic infections. But amidst all the debates, YouTube videos, blog posts, op-eds, workshops, consultant reports, tweets, counter-tweets, tweets in all-caps (e-shouting?), shockingly absent from the discussion is a simple question: how does this matter?

A computer virus - a few lines of digital code - has put the entire planet on high alert. Nowhere is this more evident than in health care, as experts and technicians are parachuting in droves to loosen the cybershackles that threaten to paralyze every wired-in hospital on Earth. Why? Have doctors and nurses lost the ability to provide care? Is the cumulative expertise of countless professionals now less valuable than the inanimate objects they punch data into? A doctor or nurse - a smart, dedicated, compassionate professional - commits suicide, and the administration sweeps it under the rug. But a computer system malfunction constitutes an all-hands-on-deck crisis? How does this matter?

This video contains a plethora of buzzwords we hear all the time: transparency; accountability; integration; governance, and so on. It's one of many that have popped up all over YouTube, slick productions that those "in the know" are supposed to be immediately grasp will make health care - a messy, human-to-human endeavor - miraculously function the way it "should". Nowhere in the torrent of jargon is anything but passing reference to the poor, the elderly, or the disabled...by far the biggest users of health care. Regardless of who holds the baton of governance, how does this matter?

At the highest levels, governments and bureaucrats squabble over responsibility, fight for control of what can't be controlled, place ever-increasing demands on workers struggling with ever-increasing rates of burnout. To the unemployed man addicted to opioids, or the frantic young woman who grew up with abuse, how does this matter?

It would be nice to think that somebody, somewhere, sometime, in a position with influence but devoid of self-interest, would take this idea to heart, would stop creating solutions where no problem lies, stop debating minutiae when no lives are at stake, and stop trying to perfect what can't be perfected. But nothing I've seen - not from government, not from administrators, not even from most health professionals - gives me reason for optimism.

Sometime in a day or two, or the next day, or the next, my phone will go off and I'll have another dead body to examine, to determine a cause of death. I'll have that momentary pause, that instance of silence between the tweets and the clicks, to think on the idea or debate of the day. I'll look down at the dead, asking how does it matter? The answer will be: it does not.

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