Faith, Perception, Fact: There Is a Difference
By
Leonard Zwelling
There
are several levels of belief. We in medicine like to think we make our
decisions based on scientific fact, but in truth, we often don’t have the facts
about how best to treat a patient. That’s why we do research. The research is
aimed at generating the facts that will later be incorporated into general
clinical practice.
In
our lives, in and out of medicine, what we believe comes with different levels
of documentation.
Faith
comes with no quantitative documentation at all. Love, prejudice, beauty and
religion are beliefs that are the products of faith.
Then
there is perception. Our senses bring information in, but our perception is
altered by our state of our mind when the data enter and the meaning of the
data is heavily influenced by that state of mind that, in turn, is affected by
faith. Music may register in the cerebral cortex of most humans similarly, but
its meaning and emotional effects are greatly influenced by our perception of
that music.
Finally
there is real quantifiable fact. The distance between home plate and the
pitcher’s mound is 60 feet 6 inches and that’s that. A 30 foot putt for birdie
is either in or it isn’t. The coronary artery is patent or it isn’t.
Right
now, Congress is having trouble distinguishing between faith, perception and
fact. While the Democrats and many Republicans are absolutely sure that ObamaCare
is the law of the land and validated as constitutional by the Supreme Court, a
cohort of delusional Tea Party folks want to defund the law or shut down the
federal government while undermining the full faith and credit of the United
States by limiting our ability to pay back money we have already borrowed. Furthermore, there are inadequate
numbers of votes in the Senate to pass this bill (that’s a fact) and the
President won’t sign it anyway (another fact).
While
I mean no disrespect, this action by the House is just plain stupid. It will
harm far more than it will help and it will probably harm the perpetrators of
this charade the most. How do I know? Because the Cruz Missile from Texas
goaded his House Tea Party brethren into passing this act and then backed away
from introducing it in the Senate so as not to have to stand for his “faith”
himself. Talk about disingenuous! Now he’s backing off from backing off. This
guy is the biggest political embarrassment in Texas and that’s saying
something!
On
Wednesday we learned that the faculty of MD Anderson perceive that the care
they are delivering is being adversely affected by the high volumes of patients
they are being asked to see due to the administration’s insatiable appetite for
money at a time when the unit reimbursement for faculty clinical work is under
downward pressure. Dr. Burke’s recent email insists that compromised safety is
not the case. We are as safe as ever. Which is it? Is patient safety being
compromised? Who are you going to believe, the docs caring for the patients or
the executive overseeing it from across the street?
I
don’t know, but I know it doesn’t matter who is right for now. The docs think
that they are not able to do their best work. At the nation’s number one place
for cancer care, that’s all the Chancellor should have had to hear before he
charged his new Executive Vice Chancellor with investigating this, sorting
perception from fact and reporting to him in 90 days. That would have been an
exhibition of leadership on the Chancellor’s part, but alas, no such luck.
Today,
we learn in the Cancer Letter that some faculty believe the ultimate patient
harm might have occurred due to the overwhelming demands on the patient care
faculty. This came from the comments received with the faculty survey, but
which had not been presented on Wednesday. That’s enough for me.
To
be blunt, someone has to lose his or her job in the patient care arena or
beyond. Given that the excuse for the perceived poor care is financial, those bean
counter guys need to share the pain, too.
I
will let each reader perceive who among the financial and clinical leadership
team should be held responsible for this incident of lost faith, awful
perception and an absence of facts, for the fact is we really aren’t at all
sure whether or not the perception of reduced safety is a fact.
One
thing I know is true. The excellence of MD Anderson has been challenged in its
sweet spot–patient care. For the first time in my 29 years, someone has
suggested that patient safety is being compromised due to financial exigencies.
The President has to do something now (actually once he learned of the results
of the survey from the meeting on Wednesday). Meetings next Monday or Tuesday
may well be too late for some of our patients, but then again, who knows? Right
now, it’s all an element of faith to me.
But
looking into my crystal ball, I see vacancies in several top offices. But then
again, you can’t perceive what’s in my ball or me in yours. What do you
think/perceive/believe?
How
much longer can we be expected to keep the faith?
