The slow work of healing

I just finished reading "Tattoos on the Heart" by Gregory Boyle. I came to it partly via Krista Tippett's conversation with him last summer at the Chautauqua Institute, and partly through other sources. It is a far-ranging account of his work over the last 20 years with the members of toughest Latino gangs in LA through his non-profit Homeboy Industries. The book is suffused with love for these societal outcasts and peppered with wisdom, some in the Christian and some in other traditions, including secular.

What does a book like this have to do with healthcare? Well, a lot. There are many points that might help rehumanize clinical medicine. But this passage on page 179 really made me stop in my tracks:

Funders sometimes say, "We don't fund efforts; we fund outcomes." We all hear this and think how sensible, practical, realistic, hard-nosed, and clear-eyed it is. But maybe Jesus doesn't know why we are nodding so vigorously. Without wanting to, we sometimes allow our preference for the poor to morph into a preference for the well-behaved and the most likely to succeed, even if you get better outcomes when you work with those folks. If success is our engine, we sidestep the difficult and belligerent and eventually abandon "the slow work of God."

Now, I am not Christian or even particularly religious. I am, however, a fan of the Jesus persona who merged with the poor and the hungry and the downtrodden, who became the change he wanted to see. And I had to re-read this paragraph several times, particularly the last sentence. Is this not exactly what we are seeing in medicine? We have told ourselves a lie that by chasing only those outcomes that are quantifiable we are pursuing only that which is important. But wasn't it Einstein who said that not everything that counts can be counted, and not everything that can be counted counts?

Is this gaming of the system that Father Boyle talks about in the paragraph above not exactly what we are seeing as the end-result of the perversion of the idea of evidence-based medicine? What if we change a few of the words in the above paragraph (and stick to secular language)? Will it fit what is happening in medicine today?

Payors Funders sometimes say, "We don't fund efforts; we fund outcomes." We all hear this and think how sensible, practical, realistic, hard-nosed, and clear-eyed it is. But maybe Jesus doesn't know why we are nodding so vigorously. Without wanting to, we sometimes allow our preference to help the sick for the poor to morph into a preference to take care of for the well-behaved and the most likely to succeed, even if you get better outcomes when you work with those folks. If success is our engine, we sidestep the difficult and belligerent and sickest and eventually abandon "the slow work of healing God."

I don't have the answers to how to solve our fiscal and quality crises in medicine. Well, I do, but they involve a cultural overhaul of the entire US of A. But this paragraph sure is making me think.

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