Win Win Win

I have been on a binge of hippy dippy economics books lately, and the term "Gift Economy" is batted around quite a bit. The central idea is that one does good for others without expectation for any direct return. Instead, if you see a need, you help relieve it. Later when you have a need, others will help you. Pay It Forward, What Goes Around Comes Around, etc. One of the hopes is that since needs are met specifically, without dickering or acquisition, that resources are efficiently distributed. In addition, there is a profound effect living under this system has on how people feel about their place in the world.

In contrast, monetary systems make transactions numeric, self-focused, and are necessarily inefficient because of the time and effort to arrive at a price arrangement. That is, once money is involved, transactions tend toward zero sum propositions, or worse. (Certainly, monetary exchanges can be mutually beneficial, but introducing money can at best and usually hinders making an interaction "win-win.") At worst, money encourages relationships that are parasitic or predatory.

Our entire world has become increasingly digitized, monetized, and standardized, and many of the "advancements" of our current civilization are dependent on that fact. Standardization of medical practice is in my mind a very good thing. National Guidelines, Best Practices, Clinical Pathways, are all excellent tools that do improve care when applied appropriately. However, the "number-izing" of our lives has made us assume that everything is Zero Sum when best case scenario is instead a "win-win."

How does this apply to Better Medicine? This is the problem I've been asking myself over and over these last weeks.

The first and perhaps most important application is the most difficult. It is simply the switch in internal motivation back to the helping orientation that sends almost all into the medical field in the first place. When I walk into a room, first and foremost I need to think "What is this person's need?" and "How might I be able to help?" Most patients assume that is what is on my mind or are angry because they know when it is not. In medical school, we are taught to think about diagnosis and treatment and by the time one has finished at least 7 years of repeated practice and review, this is successfully instilled. The part of our behavior that is shaped is what is measured and reviewed.

Similarly, once a doctor is out in practice, what is reviewed is most commonly number of patients seen, money flow, and at best clinical outcomes that are almost always numeric measurements. "Patient Satisfaction" is occasionally measured. As a result, providers are conditioned to think about these items more and more as they progress in their careers. Lawsuits also weigh on nearly ever provider's mind, which further make the doctor-patient relationship at least more distant and at worst frankly confrontational. This group of disconnects is as much a part of the collective dissatisfaction with American medicine as the cost burdens, in my opinion.

We must create a system where our first question is "How can I serve this person's need?" This is basis of the gift economy. The answer will overlap frequently with diagnosis and treatment, and yes sometimes with questions about cost. We must make it easier for the provider (whether doctor, front desk, or nurse) to not worry about what is coming back to them. They need to feel safe that as long as they are caring for the patient's needs to the best of their ability, they will be safe and taken care of.

How do we make the human interaction of caring for the ill truly a win-win? How do we change the perception of the sick toward fellow humans in needs instead of a potential market? How do we take fear out of being a provider?

Maybe we start by seeing our interactions as gifts instead of purchases.