Original Publish Date: October 3rd, 2023
“If we open a quarrel between past and present, we shall find that we have lost the future.” Sir Winston Leonard Spencer Churchill
The Age of the Gladiator
A long time ago on Planet Earth, health care practitioners drilled holes into the skull to cure illnesses (trepanation). An even longer time ago, the same profession employed leeches or simple cuts to the vein as a means to rid the body of “bad blood” (bloodletting). Not so long ago, mental health practitioners severed connections in the brain’s prefrontal cortex to treat psychiatric disorders (lobotomy). All three examples underscore the ways in which health care employed medical science as much as it relied upon art. While the scientific process was largely responsible for advances in health care over the centuries, artistic moments defined miracles, eventually known as epic innovations.
Today’s box within which health care exists leaves little room for either professional or financial error. As a result, health care practitioners default to placing all square pegs in square holes without considering the opportunity to test round ones. If hospitals consisted of a sport played by two teams of eleven players on a rectangular field with goalposts at each end, the practice of medicine could be rebranded as “prevent defense”.
Modern Day Health Care
Within this landscape exists the institution upon which we depend for matters of life and death. The insistence of consistency, however, is not without value. By ritualizing presurgical verifications, the number of avoidable errors in the operating room substantially decreases. Painstaking dependence on temperature, heart rate and blood pressure establish a remarkable foundation for all hospital patients irrespective of the diagnosis. An obsessive-compulsive approach to cleanliness and sterility in hospital settings profoundly impacts the ability to prevent infection, while at the same time does not trigger 300.3 (F42) from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
To be sure, few yearn for more pen and pocket-knife tracheotomies, and practically no one enjoys a tracheal intubation while awake. Still, the lucky recipients of either, and who still walk this planet, most likely champion both, as well as the notion that medicine must be part science and art. Gone are the days when Dr. Klein (played by Barton Heyman) from The Exorcist could stand firm on his temporal lobe diagnosis: “The problem with your daughter isn’t her bed, it’s her brain.” Similarly the ways of Gregory House (played by Hugh Laurie) are also leaving the hospital bedside: “It’s a basic truth of the human condition that everybody lies. The only variable is about what.” Replacements for both came in the form of Dr. Alphabet Inc., as well as anyone else with a computer and Internet browser.
The Art of the Miracle
The human body is nothing short of a masterpiece, which requires medical science to understand subjective and objective. Modern medicine, however, relies upon the objective to avoid risk in the form of lawsuits and regulatory challenges while potentially shunning dynamic and cutting edge progress. The subjective mind is responsible for some of health care’s most important developments over the past century, such as antibiotics, diagnostic imaging, angioplasty, statins, laparoscopic surgery and organ transplants. Commonplace procedures today were science fiction a century ago, the development of which did not result from defensive medicine or unwavering adherence to criteria established by governmental or quasi-governmental boards attempting to assess the masses in a fair and just manner.
Health care should always save a seat for the proverbial Hail Mary, commonly known in American football as a very long, forward pass often made in desperation with an exceptionally low probability of success. Rate of completion notwithstanding, few will ever forget Roger Staubach’s 1975 pass to Drew Pearson, Tommy Kramer’s 1980 miracle to Ahmad Rashad, Aaron Rogers’ 2015 touchdown throw to Jeff Janis, Doug Flutie’s 1984 shot to Gerard Phelan, or Jim McMahon’s 1980 Holiday Bowl sensation to Clay Brown. These handful of Hail Marys, even in the context of Tom Brady’s 2022 single season record of 733 pass attempts, remain a foundational element behind Joe Burrow’s $55 million salary in 2023.
The Science of Broken
There are myriad reasons why health care remains stagnant and broken, most of which will take far longer to heal than Aaron Roger’s Achilles injury. Health care built its highway in 1965 with the passage of Medicare, and this remains today the road most travelled. No longer anything close to linear, health care has perfected the combination of complex and convolution, whether in the form of statutes upon regulations upon administrative guidance upon case law upon billing manuals, an unimaginable budget cut by as much as twenty percent each year due to fraud, abuse and waste, an underwhelming sense of trust from the individuals for whom the federal government made this thoroughfare, or an aging and disgruntled army of chauffeurs who no longer tolerate the system’s state of disrepair much less the increase in potholes practically around each corner.
That modern technology in health care exists only on Myanmar’s Yangon-Mandalay Expressway possibly underscores the system’s greatest failure. Access to all of the bells and whistles in health care remains challenging as patients stand frozen on the battlefields of a war between payers and providers that has no end in sight. Assessing blame is no longer possible, as members within the ranks of both sides are guilty of unbelievable atrocities. While it may seem easy to draw a line between patient and provider that breaks only when the payer interferes, many forget that the system itself empowered the payers decades ago to draw the lines as well as the infrastructure within which these lines were originally placed.
The Need to Prevail
Health care has always been, and will always be, a triangle, which by definition is a polygon having three sides. The geometric shape of American health care defines the system’s architecture and serves as the foundation upon which health care’s capacity to heal exponentially expands. The system appears more and more fragile as the science behind medicine eclipses its lost art. For health care in the United States to survive, the system must incorporate creativity, even if that means the triangle begins to resemble something abstract. Maybe health care can learn how to abandon the protractor and still retain all three sides, but only if the system allows art to return as a means to compliment the science. And possibly to draw outside the lines.
Craig Garner is the founder of Garner Health Law Corporation, as well as a healthcare consultant specializing in issues pertaining to modern American healthcare. Craig is also an adjunct professor of law at Pepperdine University School of Law. He can be reached at email@example.com.