Thursday, July 16, 2009

A Willing Suspension of Magical Thought

Actors and playwrights know that “a willing suspension of disbelief” is essential for the successful acceptance of any fiction. Such faith allows us to enjoy the greatest of entertainment, be it Samuel Beckett’s “Waiting for Godot” or Matt Groening’s “The Simpsons.” Without a willingness to forego our skepticism and socially inculcated, rules-based orientation, we would forever be ingrained in a world of columns and rows and formulaic drudgery.

This is the essence of “magical thinking.” It allows us escape from our cubbyholed, preconceived mindsets. It enables flights of fancy, free association, and the perception of the possible. It is enabled from birth (genetically programmed?) as evidenced by watching any child at play. It allows us some of our greatest kidhood fantasies and fears. (Think: Santa, Tooth Fairy, Easter Bunny, Boogey Man, and all those monsters under your bed.) Magical thought allows magicians to amaze us and artists to enthrall us.

Unfortunately, that same ready power of mental delusion is what also allows us to believe that politicians really do mean what they say this time, that bankers really can self-regulate themselves adequately, that insurance companies are there for our protection, that technology can solve our healthcare crisis. It permits the fantasy that ARRA money will wind up helping heal healthcare and not just bulking the bankrolls of EHRco bigwigs and bolstering Insco bottom lines.

I love my fantasies as much as anyone. I would absolutely love to believe that information technology will put a period to my pen-and-paper-based problems, end my seemingly ineluctable non-electronic errors, provide instant access to the information I need as I need it, give me gobs of great evidence-based new brain power, and stop the shrinkage of my already skinny sliver of practice profit. However, I am unable to relinquish the disappointing deduction that the current rush toward IT as the “end all, be all, cure all” for healthcare is poorly planned at best and an impending catastrophe at worst.

For those who live and work in highly technical worlds, where the people you see daily are digitally oriented and adept, it is probably not an unreasonable reach to assume all things digital are possible. But, when I drive around my little corner of middle America, I see loads of folk whose electronic skill sets are likely limited to TV remotes and ATMs...at best. Where I work, I encounter colleagues who would love the aforementioned techno-advantages, but who barely have enough time to unravel the mysteries of CPTs and ICD-9s, no less the quandaries of an entirely new EHR-demanded workflow. Where I practice, I live the daily dilemmas of bringing the non-techno-literate along as we endeavor to navigate our way across the digital divide.

In considering this piece, I Googled “magical thinking” which brought me immediately to a great article by
Gilles Frydman with comments and links to related pieces by such HIT notables as David C. Kibbe, Sarah Greene, John Halamka, and e-Patient Dave. Agree or not, all are worth a read, though perhaps the best, from the view of a grunt in the trenches, was a shorty by e-Patient Dave where he highlights the neglect of the everyman in this HIT stampede.

I want this brave, new, digital world for healthcare as much as anyone, but authentic and concrete, with real value for everyone, not just the fat cats and CEOs. Let’s suspend the magical thought and deliver truly “meaningful use” to my neighbors, Joe and Josephina Sixpack, not just the technorati.


First posted on HIStalkPractice June 27, 2009.


Delusions of grandeur make me feel a lot better about myself. - Jane Wagner

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