When the Practice Becomes the Patient

Health care is sick. But that’s not a revelation to anyone interacting with health care. It’s easy to say, but much harder to understand.

Like any system, we need to approach it like a dynamic unfolding. Challenge with healthcare is that the incremental pace at which it changes makes those changes almost imperceptible. We would need a time lapse camera spread out over decades to really see the very subtle movements that have influenced the direction of health care. The fax machine, which is still widely in used in health care practice, is an apt metaphor. Changes in health care tend to move at the same slow pace that a piece of paper feeds into a fax machine.

So why do we struggle so much to invite change into the health care system?

Find me a policy maker or health care leader or a patient or caregiver advocate and I will find you countless good reasons why the system is stuck in an era of fax machines - too little time, too little money, too little will, too short policy cycles - the conventional thinking is that there is too little of everything. Yet, we continue to spend more on everything, and outcomes never keep pace. If you’re looking for a failed experiment in “more is better”, look no further than the US health care system. You can just as easily look close to home. The response to that “not enough” mindset has been to try to rejig the pieces on the chess board of health care, or to throw more pieces on the playing board, or to try to get the pieces to work together. This is why change in health care often feels like piece-meal.

Here’s another perspective; maybe the chessboard itself is no longer serving us. Maybe the confining playing field that we built around health care is cutting off the very oxygen it needs to be resuscitated.

Einstein was famous for saying that you can’t solve a problem from the same level of awareness that created it. Modern health care has been dominated by very specific notions about how we should make sense of the body and mind and how we react and treat the human experience of suffering. These ideas shape how we think about, show up to, and build structures around health care, including shaping the public consciousness around health. These ways of making sense of health care set the boundaries and invite a certain way of “playing the game”. For decades our thinking around nutrition was dominated by a food pyramid that had little structural integrity. A limited outlook shaped a narrow container that held a narrow understanding of what is healthy food. You can still see those outdated nutritional practices in hospitals across Canada. The most progressivist health care professionals will tell you that health care thinking and training has not kept pace with emerging truths about who we are and what contributes most to health, healing, and well-being. We’re living longer but living longer with less joy. Even our metrics don’t make real sense. And yet, we persist.

If we are going to change health care, then we need to expand the way we are thinking about health care. We need to push the boundaries beyond their current constraints.

I don’t want to make any claims to having all the answers. I am only suggesting that we need to start asking better questions. Better questions arise from a place of curiosity and care – the great virtues of scientific inquiry and compassionate health care practice. I don’t know if health care can find the courage to undertake this deeper reflection. One of the hardest things to do is to get anyone who is drowning to take a moment of pause and think more reflectively. I am only suggesting that the confines of the pool that is holding health care in its current pattern of thinking is exactly what is inviting that experience of flailing, lungs filling to capacity, and slowly draining its life force. To move forward we need to find the courage to pull the plug and allow the water to drain. Only then can we get an honest perspective on why we find ourselves in a kiddy pool of our more limited understanding.