Category: Human Scale

Healthcare’s Age of Acceleration


I recently finished Thomas Friedman’s excellent book, Thank You for Being Late: An Optimist’s Guide to Thriving in the Age of Accelerations. In it, Friedman makes that case that we are living through an unparalleled time, marked by what he calls “accelerations” that are happening faster than humans are able to adapt.  He argues that we are living through the most dramatic inflection point since Gutenberg and the subsequent Reformation in Europe.

15544113057_23824f069e_zFriedman argues that the three primary forces shaping events are advancements in technology, global interconnection and climate change.  What is notable about these three forces is that they all show signs of exponential change, not linear.

As an example, here is an illustration from the book showing the exponential drop in the cost of DNA sequencing, plotted against the trajectory that we would have seen according to Moore’s law (which would predict a doubling of computing power every 1-2 years).


The problem with these “hockey-stick” exponential curves is that technological change happens more and more quickly (aided by the”standing on the shoulders” of earlier technology).  The change happens faster than human’s abilities to adapt.


I’m taken by Friedman’s arguments.  I’d argue that one of the reasons that healthcare workers have felt so discombobulated over recent years is exactly this issue of unimpeded technical acceleration that exceeds physician’s abilities to acclimatize.

Atal Gawande touched on this during his Stanford commencement speech in 2010, reprinted in the New Yorker:

The truth is that the volume and complexity of the knowledge that we need to master has grown exponentially beyond our capacity as individuals. Worse, the fear is that the knowledge has grown beyond our capacity as a society. When we talk about the uncontrollable explosion in the costs of health care in America, for instance—about the reality that we in medicine are gradually bankrupting the country—we’re not talking about a problem rooted in economics. We’re talking about a problem rooted in scientific complexity.

Besides discombobulating physicians, I’d argue that scientific and technical complexity also threatens to overwhelm patients. Our ability to do increasingly exceeds our ability to decide what to do… You can see this dynamic during every complicated end of life discussion, where the technical promise of immortality seems often at odds with human needs.

In an earlier post I wrote about the concept of “human scale”

In philosophy and design circles there is a concept known as “human scale”.  The general idea is that we humans are best able to engage with a world that is similar in scale to the way we are built. In a universe that ranges from atomic to cosmos-sized, measured by time periods ranging from subatomic to geologic, we humans optimally engage with what the brilliant scientist Richard Dawkins calls the “Middle World.”

This Middle World is measured in pounds and feet, and in minutes and lifetimes.  Steps, corridors and wall-heights in our buildings reflect the length of our legs. Our senses and intuitions work best at this scale: nobody has “commonsense” ideas about the orbit of an electron, but we do about, say, catching a bus. When things become too big or complex, they can become abstractions and our “commonsense” no longer applies.

Here’s my bet: going forward, physicians aren’t going to need to be technical experts.  Instead, in the age of computer learning, the physician is going to need to be the person who makes healthcare human scale.  That’s the important work ahead.

Friedman, incidentally, arrives at a similar conclusion.  He writes:

…the highest-paying jobs in the future will be stempathy jobs— jobs that combine strong science and technology skills with the ability to empathize with another human being.

Photos:  Don McCullough cc license, Flikr


On the Interstitium

For years I worked as a pediatric emergency physician staffing the only Level One pediatric trauma center in what was (and is) one of the poorest states in the union.

Tragedy is a regular visitor in these kinds of places. Among the usual hordes of kids with sore throats, and bronchitis, and assorted rashes there were the true horror stories:  the children who arrived silent with fear after car crashes that battered their families, and the kids found face down in pools.


At times like that our team would pull together, working quietly and with great purpose: around the bed would gather the nurses who had been at this for decades, the respiratory technicians, the wide-eyed residents, sometimes frightened parents who often looked as though they’d been torn apart atom by atom.

At those times, while we worked on tiny children, I often had the sense that we had somehow entered a different place defined by its amorphous nature, without walls or structure. Time was marked by the completion of tasks: the placing of a line, the passing of a tube, the addition of a medicine or the change to a ventilator setting.

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Humanizing the Healthcare Machine: On Not Getting Lost in the Warehouse

One summer afternoon, when I was eight or nine, I impulsively chose to ride my bike down a steep hill near my childhood home.   From the top of the hill my bike accelerated at a frightening rate and I remember for brief moments somehow being airborne before landing in a pile of bent metal and bloody asphalt.  My adventure ended with a trip to the children’s hospital for a cast and a sling.

After all of these years what I remember most from that visit was being in pain and almost vertiginously looking down a corridor into the massive, soaring atrium of a hospital packed with people that went on forever.

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