We often talk about the operational problems in healthcare. How can we deliver care? How can we decrease cost? How can we align incentives? At the periphery of these spokes, clinical care is delivered.
But the spokes of a wheel are always tethered to the hub. The hub reigns; the spokes merely deliver its power.
The hub of healthcare is our core knowledge about health, healing, life, death, growth, and disease. The hub knows, or should know, approaches to questions like:
What is health?
How do we get there?
Are we already there?
What is healing?
How do people heal?
What is a disease?
What is life?
What is death?
What is the philosophy we subscribe to?
What philosophies do other systems subscribe to?
How can we reconcile these different philosophies and systems?
How do we best define a human being?
What are the many different ways in which we can define a human being?
How do we model a human being so that our approaches to diagnosis and treatment are optimal?
Medical research and medical science live in the hub. When you see an intractable problem in health care, for example an apparently incurable disease or sky high costs, consider that tackling the problem at the operational level may not be the solution. In fact, that may be what keeps it intractable. More money may not be the solution. More doctors may not be the solution. More health centers may not be the solution. Even more research and more of the same education, if pointed in the same directions, may not be the solution.
We need an information upgrade.
In my next post, I'll talk about the implications of this for health literacy.
(Adapted from my book, Michelangelo's Medicine.)