It's cliché to note that we live in a time of great change and even great peril. Most change is offered to us as something we must accommodate or adapt to, perhaps even welcome.
l'm not so sure.
l'd like to take the long view of things, to look back in time the way the James Webb telescope can see things that are over and done. My quick view of history would note that modern humans have been around 100,000 years or so. As far as one can make out, lives were "solitary, poor, nasty, brutish and short.”
We've changed but perhaps not much.
Around 30,000 years ago, our cousins the Neanderthals disappeared, though by most accounts they were muscular folk who wore jewelry, buried their dead and had bigger brains than ours. We got along with them in some fashion, though, since their DNA persists in small amounts in many of us. No one knows why they left, though poor planning and social skills are offered up as possibilities.
Jump forward a few millennia and witness our discovery of Otzi or the lceman, a 5,000-year-old natural mummy found some years ago in the Alps between Austria and ltaly. Otzi may tell us more than we'd like to know regarding our present circumstances. First of all, he died with an arrow in his back. Beyond this, he sported tattoos and had extensive tooth decay, rib fractures, osteoarthritis, arteriosclerosis, whipworm, Lyme disease, gallstones and likely digestive troubles. He was evidently on the run and hadn't eaten for a day or so.
Some might say "you've got your troubles; l've got mine," but we can likely agree that Otzi had a lot of change to contend with.
Round the time of Otzi's death, there were great civilizations, with the pharaohs building pyramids and further dynastic enterprises in the lndus Valley, between the Tigris and Euphrates rivers, and the subsequent Greco-Roman empires. All are gone, and arguably represent failed change management.
Let's continue: next came the various Holy Wars. The Dark Ages were aptly named and beyond them, there was only slow and reluctant recognition of the value of individual humans. Lest we forget, carnage was ahead. Twenty million deaths are attributable to the First Great War; 50 million to the Second, with another 20 million or so falling prey in ancillary fashion to war-related disease and famine.
The concept of an apocalypse and its four horsemen are things we've had to contend with: war, famine, pestilence and death. The news is that there's a fifth horseman among us and, as cartoon Pogo said years ago, “It's us. The enemy is us.” There are now 8 billion of us on a small planet and, though birth rates are generally falling and in spite of what Elon Musk maintains, there are too many of us poisoning the planet and its atmosphere and plundering ecosystems everywhere.
Christoph Niemann notes, "The increasing regularity of droughts, heat waves, wild fires and deadly floods is already upon us." He goes on: "We keep experiencing things that are unprecedented, worse than anything anyone can remember, even as we're told that they will become common.”
As if this weren't enough, we've got a cornucopia of other problems, with disturbing numbers of our youth and beyond succumbing to opiates and suicide, the continuing scourge of mental health disorders and that hallmark of our time – mounting economic inequity.
We'd like to forget about our pandemic but, however muted our discussion, COVID persists, with new cases daily and the possibility of newer, alarming variants. COVID laid waste to us all, and we're left grappling with post-traumatic stress. ln its wake, the malady has left families, communities and individuals lonely, isolated, warily suspicious and alarmingly inert.
We've come to call this grim time the Anthropocene, implying that we've brought it on ourselves, that we're tangled in a digital snare of sorts, with the glib vacuity of our digitized world sorting us into vengeful tribes based on our fuzzy perception of just what's gone wrong and our general truculence.
ln particular, our multifaceted dilemma has played out in health care with a workforce that's been hollowed out and plagued with overrun emergency rooms, poor staff morale and a near-insurmountable backlog of work left over from the COVID shutdown.
Dare I mention that the system was already overburdened long before SARS-CoV-2?
Let me return to my fanciful use of the James Webb telescope permitting glimpses of old history. Looking at to our present circumstances, one might say that things haven't gone so well and add that our prospects don't look so good either. Hope, in fact, isn't much of a plan, and we've got to do better going forward.
l'll note there are only two kinds of change: good and bad. lt's important to know the difference, of course, since so much we're inflicted with is change that's either bad or, at best, insignificant.
Let me address health care: our overwhelming need just now is to understand clearly just where we are. We must understand the demands on our system, the clear and measurable resource and capacity issues and know them well enough that they can become publicly acknowledged with measurable parameters that can gauge our further progress (or lack thereof!). Another radical idea is to harvest ideas from the people involved – workers, middle management and the various boards and CEOs that have been shelved. They likely have truths to tell, perhaps even advice.
The recent decision to restructure AHS and to divide its responsibilities by function smacks of judgement failure, ignorance of AHS's muddled history, change for change's sake – or perhaps most likely a combo of all three. How many times must AHS reinvent itself? Some years ago, a deputy minister, long since transitioned to other parts, warned the government of that the day that major change in provincial health care would leave the health care environment in shambles, in a disarray that would take seven or eight years to dissipate.
There's an injunction that physicians hear in their sleep: primum non docere. The Latin translates to warn “do no harm” and has become the touchstone for clinical care. lt works and should serve as caution for would-be-tinkerers with an enterprise already suffering and exhausted.
Now, moreover, may not be the time for activity on many fronts – and l'm thinking beyond our endless meddling with health care to the civic and not-so- civil projects that clog roads and parks and communities with activities that are everywhere and all at once. We're overwhelmed. Now would be a better time to rest, heal, consolidate, reconnoiter, regroup, whatever, to see if we can come together and be, well, more reasonable.
l'm of the view that my friend, the mummified lce Man, Otzi, dead now 5,000 years with an arrow in his back and multiple ailments, might agree.
l'll say it again, in closing: first do no harm.
The views, perspectives and opinions in this article are solely the author’s and do not necessarily represent those of the AMA.