Wednesday, October 29, 2014

Uncertain Health in an Insecure World - 4

"And Now for Something Completely Different" 
If the 1971 cast of Monty Python’s Flying Circus ran a health care system, it would indeed be “something completely different”. Some days, health care feels like fractured sketch comedy, without the humorous consequences.

“And finally, Monsieur, a wafer-thin mint”. (Mr. Creosote then explodes)

Health care’s systemic fragility is laid painfully bare in the face of a crisis. For example, emerging viral pandemics spike baseline global public health uncertainty. But any health crisis, it seems, can trigger an implosion – the world’s tightly linked geopolitical security networks and global economic markets quickly unravel. 

You know things are getting serious when your stock exchange’s trading breaks are applied on the same day that your health system’s hospital bed-blockers are removed. You can smell ‘SNAFU’ when the U.S Congress takes respected Centers for Disease Control & Prevention (CDC) leaders to the woodshed, while President Obama appoints the first ‘bad bug’ (not drug) czar. You might rightfully be perplexed when watching a patriotic BBC-1 lead story on Royal Navy hospital ships being compassionately dispatched to Sierra Leone, while reading The Times’ unsympathetic headlines about U.K. midwives striking for the first time in thirty years over a pay hike.

Failure to see the signs of something bad coming – what Margaret Heffernan calls “willful blindness” – is a recognized risk that reaches beyond Enron or British Petroleum into health care. When mental models of how things are supposed to work fail massively, as was the case at NHS’ Mid Staffordshire Hospital, vulnerable patients die. When hospital boards succumb to the biological basis of bias, becoming too comfortable with the familiar ‘self’, they can indeed be indicted for criminal corporate manslaughter.

“Look Matey, I know a dead parrot when I see one”.

John Cleese took his pet shop one-man line of inquiry with Michael Palin (Mr. Praline) to an absurd finale - 'The Lumberjack Song' - on a British Columbia river.

The likelihood of a collective response to health care system failures (or crises) is inversely related to the number of observers. Cumulatively, we run a greater risk of becoming victims of a health care “bystander effect” than being victims of Ebola.

So, are you floating merrily down the silly river?

Or are you stepping boldly into the real world... into The Square?

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