I heard an NPR segment a couple years ago featuring a physician / author arguing that there was no reason a visit to the hospital couldn't be analagous to a dinner at the Cheesecake Factory. I had to turn off the radio; I felt physically nauseous. I wanted to grab that pseudo-doctor by the lapels of his ( I imagined) Brooks Brothers tweed and shout "What are you doing! Actual, un-informed people are listening to your tripe and think it's true!" You can't compare a fine-dining experience that people willingly and briefly partake of to an unwilling stay at a cinder-block instutution packed with suffering - it's apples and oranges!
Unfortunately, the incomprehensible and incomparable nature of today's health care cries out for a parable to render it relevant and last Friday I attended a healthcare simulation conference where they trotted out their Sermon on the Mount of analogies: the airline industry and its incredible safety record. Capt. Chesney Sullenberger and his miracle bird-strike landing of US Airways Flight 1549 on the Hudson River always gets plenty of play (although he admitted he'd never practiced that scenario in the simulator).
Any high-risk organization likes to utilize simulated scenario training to increase safety: the military, nuclear industries, healthcare, and flight - indeed, airlines have set the standard for simulation and very nearly perfected it. Simulation is a powerful and adaptive winnowing tool, incredibly effective at producing near-realistic arousal states and responses in a safe environment. The fighting soldier, the suburbanites dwelling in the nuclear silo's shadow, air travelers - all are much safer today than the mid-20th century, in large part because of the rigorous simulator training, but also because of better protocols, procedures and communication. There are also personal investments to consider: 3 people sit in the cockpit flying the plane and each is enthusiastically motivated to have a precisely equal number of take-offs and landings - U.S. airline disasters have fallen to nearly zero. This number is held up as a shining target for the U.S. healthcare industry since, alas, hundreds of thousands of people are dying in our hospitals!
Because that's where people go to die, you tweedy, ivory-tower-hunched, statistics-blind cretins!
I love healthcare simulation, obvously, since it's my profession. I think it's invaluable and I can't wait to see it evolve into a more realistic, more refined, more flexible tool. But you can't compare the training that makes a mechanical flying machine driven by three people safer, to the training of a few worker ants that scuttle around the anthill of a hospital - it's apples and oranges. A better analogy might be; a hospital is like an enormous kennel run by veterinarians and their assistants and business partners that outnumber the animals 2:1, but that falls short too, because the 'patients' - while fed, sheltered, medicated, their diseases treated and heads petted - can also be caged, controlled and legally euthanized. A street poll of most humans would reveal this to be unsatisfactory healthcare.
I don't know that there is a good parable to unpack the complexity of western medicine, so I'm uneasy with the slavering after an unattainable goal like zero airline fatalities should equal zero hospital fatalities, despite some truly outstanding presentations on the topic by people I highly respect.
People want to board an airplane and pay good money to do so with an expectation that, allowing for a few variables, they will fly through the air to their destination by harnessing the immutable laws of physics to overcome the immutable theory of gravity. Now that we know how to do it, it's an expectation that's almost always met. It's largely done by a machine - as long as the cold, dumb parts don't fail, you'll get to Kalamazoo.
People do not want to enter a hospital but usually have to, accompanied by the unrealistic expectation of a rapid and glowing return to normal health. 60% of the time they have no money to pay for services but receive them anyway thanks to the onerous burden carried by the rest of us. 90% of the time (this is a real statistic for abdominal pain), despite the best technology available, some of the most highly-educated humans on earth can't reach a definitive conclusion as to why the person is suffering but don't want them to leave empty-handed so offer a palliative medicine for that suffering that is then trumpeted on the cover of TIME magazine as the gateway to the downfall of civilization. In our instant-gratification, media-saturated society, healthcare can't win - the immutable laws of physics and chemistry cannot overcome the immutable law of biological decay. It's important and exciting to create simulated scenarios that prevent unnecessary deaths, but there's no simulation that can bring the death rate to zero. Perhaps patients themselves could reduce that rate a little if they spent less time peering through their tobacco smoke to excavate the last pork-rind in the bag and more time enjoying fresh apples and oranges,but I'm no doctor - just a realistic sim geek who, in the face of humankind's relentless fatalities, is trying to put the care back in healthcare.
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