This is the two year mark, and I am back where it started: Mayo Clinic, Scottsdale Arizona. As before, I find myself surrounded by some of the most incredible people, each tremendously inspirational in their devotion to advancing our understanding and treatment of disease processes, and in particular, cancer. And so it is worth making the comparison again: what are we doing right here, what could we do better, and how can we take the lessons learned from such a successful system and apply them to other important areas of our society?
The most impressive lectures were about the newly released cancer staging manual. This is a book that standardizes the way we assess a patient’s cancer to help us plan treatment, and to better understand what works and what doesn’t. It is based upon lessons from the past, but helps us gather information going forward.
There are three important lessons:
First, the manner in which the manual was created and the way the information is distributed is continuously being improved. The number of contributing individuals, institutions, and countries has tripled. As our amount of understanding has increased, so has our understanding of how we need to apply that knowledge to make real world changes. In fact, the body of information is now so large and the rate of change so significant that we can no longer wait for additional updates to be printed (it’s a 1000 page book now). It will now be available online so that it can be edited in real time, and there is an evolving API. Not only are we advancing our understanding and treatment of disease, we are evolving the way we implement those advances.
(The way we govern ourselves has changed little in 200 years).
Second, the level of expertise of those responsible for this manual is increasing. As the quantity of knowledge expands, the area in which an individual can maintain the needed level of mastery gets smaller. Even the most gifted cannot keep up with the current literature in every field, so the number of people needed to effectively manage the process increases, and the focus of each party gets proportionally smaller. As our overall system becomes more complicated, we have increasingly stringent requirements for the participants. And we have to: the leaders in medicine need to be the best in their fields.
(Despite the increased complexities of our society, we still refuse to place any demonstration of ability or requirements for eligibility on our leaders).
Third, the sheer volume of information is growing exponentially. It is estimated that we are doubling our knowledge every decade, but even that rate may increase. Each year, it becomes harder and harder for doctors to remain up-to-date. We are managing that through sub-specialization and the development of care networks, but the unspoken reality is that there is a growing gap in our collective understanding of disease and the education of the average patient. We are creating complex treatment algorithms, but how is a patient supposed to understand the implications of risk and benefit of options if an advanced medical degree is needed just to read the instruction book? We in the medical community have to figure out how to effectively educate our communities. A lack of understanding not only limits the ability to make good choices, it makes us vulnerable to those who would use our fears and misunderstanding to their advantage.
(The issues of our world are increasingly complex, and without complete understanding, we can’t make educated decisions. And yet we are not evolving the way we educate ourselves about those issues, and instead remain reliant on systems we know to be deeply and increasingly flawed).
In medicine, there is a cultural difference to that of our government: we seek out roles in this field to improve the lives of our fellow man. We strive to continuously improve every facet of our system, working together to an ultimate goal. But that is not the culture of government. The culture of government is to win: to beat the opponent in an election; to draft the adopted legislation, and repeal that of the enemy; to demonstrate superiority of one’s party and philosophy, and beat down the opposing view, even though that view is held by our neighbors and countrymen, not a true enemy. The culture of medicine is working. The culture of our government is not.
We started our country because we sought to improve the way we govern ourselves, to move from an oppressive system of kings and dictators to one that is vastly more just. And we have led the way for humanity. But how are we to continue to progress if we don’t even recognize that we need to move forward?