It’s hard to fend off
the vertigo of a constantly
shifting
perspective.
But is there any other way
to see?
Sometimes the ten thousand foot view
is calm and clear
while trouble
brews below.
And sometimes a moment
resolves as it should
for one single, significant person
while blackening storm clouds
gather overhead.
Who’s to say
what the weather really is?
And how can the needs of the masses
mean more than the one?
It’s a delicate tightrope
we walk,
when we try to say what matters
and to whom.
It all depends on who’s looking
and from where.
Thursday, March 7, 2019
Tuesday, February 12, 2019
Thoughts on Health Care Policy debates
In what I often think of now as a former life, I spent a decade or so in academia. I earned a BA and an MA in English Literature, reading primary works of authorship as well as critical analyses of those works, and writing my own analyses for contribution to that storehouse from which I drew interpretation. I taught composition and literature at three different universities, first as a graduate teaching assistant and then as an adjunct faculty member. I could wax eloquent on any number of themes, characters, plots, and lines from prose and poetry. And I thought I was making inroads into expanding the creation and appreciation of the literary arts in the world around me.
Then my family grew and my husband’s obligations in medical school and then residency increased, and I dropped out of the academic world to pursue full-time domestic and matriarchal obligations. I also started writing my own “great American” novels, and what I discovered was not pretty. It’s much more difficult to write a novel than it is to critique one. I have written and revised three full-length novels. And I’ve had ample opportunities to use my editing skills to polish and hone the prose of multiple authors. The creation process is far more difficult than any amount of critical analysis I’ve ever done.
And while I’m not saying that critical analysis has no place in problem-solving, I do wonder if it merits the high value we seem to place upon it. Take the Donabedian model for measuring quality care, for example. I read about this model during my outside research for my substantial writing paper, I found an article in the Journal of the American Board of Family Medicine titled "Direct Primary Care: Applying Theory to Potential Changes in Delivery and Outcomes" by Evan S. Cole, PhD that attempted to evaluate Direct Primary Care using Starfield’s adaptation of Donabedian’s Struc- ture-Process-Outcome conceptual model.
My impression, after reading about Danobedian’s model in its own words, was that it was a lot of abstractions designed to sound impressive but without adding anything of real value for innovators trying to solve problems in the field of healthcare. It reminds me of the Confucian proverb about lighting a single candle versus cursing the darkness. I often get the sense that critics, scholars, and committees spend their time measuring and analyzing the darkness, weighing the pros and cons of hypothetical solutions (LED vs. halogen vs. CFC vs. incandescent) and making suggestions for what changes should be made but not actually doing anything about the problem. Meanwhile, the few innovators in the field light candles and listen to criticism from those critics, scholars, and committees because their solution isn’t big enough, doesn’t light up the space enough, and has downsides like using nonrenewable resources or adding to air pollution.
But every society and civilization has limited resources in terms of intellectual capacity and time, not just money. Has anyone ever scrutinized the committee and scholarly methods of solving problems? There’s a saying about a camel being a horse designed by a committee, and I don’t think it’s that far off base. Where is the study comparing solutions designed and implemented by pundits against solutions designed by the boots-on-the-ground? All the research and thinking and talking and designing represents non-renewable resources. In those terms, the cost of these solutions is astronomical, but does it produce better results?
I’m not saying we don’t need people to do studies and look into this incredibly complex and far-reaching problem. I am saying that if the results of those studies will be to place the vested players under a microscope, maybe we should examine whether the studies themselves are valuable. Could all of the time they spent gathering and analyzing data, reporting back to one another, discussing and producing reports, and creating models for measuring quality care be better spent on something else? Like actually doing any one of the many things they suggest other people do to solve the problem in the first place?
The further I get into academia, the more I feel that sometimes—maybe even often—it is part of the problem. It’s a misallocation of resources that ends up costing the system it’s designed to ameliorate. And I wonder if the cost to the system is greater than the gains it produces. I think maybe someone should look into that.
Then my family grew and my husband’s obligations in medical school and then residency increased, and I dropped out of the academic world to pursue full-time domestic and matriarchal obligations. I also started writing my own “great American” novels, and what I discovered was not pretty. It’s much more difficult to write a novel than it is to critique one. I have written and revised three full-length novels. And I’ve had ample opportunities to use my editing skills to polish and hone the prose of multiple authors. The creation process is far more difficult than any amount of critical analysis I’ve ever done.
And while I’m not saying that critical analysis has no place in problem-solving, I do wonder if it merits the high value we seem to place upon it. Take the Donabedian model for measuring quality care, for example. I read about this model during my outside research for my substantial writing paper, I found an article in the Journal of the American Board of Family Medicine titled "Direct Primary Care: Applying Theory to Potential Changes in Delivery and Outcomes" by Evan S. Cole, PhD that attempted to evaluate Direct Primary Care using Starfield’s adaptation of Donabedian’s Struc- ture-Process-Outcome conceptual model.
My impression, after reading about Danobedian’s model in its own words, was that it was a lot of abstractions designed to sound impressive but without adding anything of real value for innovators trying to solve problems in the field of healthcare. It reminds me of the Confucian proverb about lighting a single candle versus cursing the darkness. I often get the sense that critics, scholars, and committees spend their time measuring and analyzing the darkness, weighing the pros and cons of hypothetical solutions (LED vs. halogen vs. CFC vs. incandescent) and making suggestions for what changes should be made but not actually doing anything about the problem. Meanwhile, the few innovators in the field light candles and listen to criticism from those critics, scholars, and committees because their solution isn’t big enough, doesn’t light up the space enough, and has downsides like using nonrenewable resources or adding to air pollution.
But every society and civilization has limited resources in terms of intellectual capacity and time, not just money. Has anyone ever scrutinized the committee and scholarly methods of solving problems? There’s a saying about a camel being a horse designed by a committee, and I don’t think it’s that far off base. Where is the study comparing solutions designed and implemented by pundits against solutions designed by the boots-on-the-ground? All the research and thinking and talking and designing represents non-renewable resources. In those terms, the cost of these solutions is astronomical, but does it produce better results?
I’m not saying we don’t need people to do studies and look into this incredibly complex and far-reaching problem. I am saying that if the results of those studies will be to place the vested players under a microscope, maybe we should examine whether the studies themselves are valuable. Could all of the time they spent gathering and analyzing data, reporting back to one another, discussing and producing reports, and creating models for measuring quality care be better spent on something else? Like actually doing any one of the many things they suggest other people do to solve the problem in the first place?
The further I get into academia, the more I feel that sometimes—maybe even often—it is part of the problem. It’s a misallocation of resources that ends up costing the system it’s designed to ameliorate. And I wonder if the cost to the system is greater than the gains it produces. I think maybe someone should look into that.
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