No Magic Bullets: Health By Incremental Steps
All of us have a deep-seated desire for a quick fix to our problems. We’re on the lookout for a fast and easy solution to what ails us. Sometimes, we find one; we restart the computer and everything works again. Experiences like this support the idea that we can instantly overcome our challenges with one intervention, the miracle.
We are encouraged and trained, really, to look for big-bang successes, in all realms — education, health care, politics, you name it — and while I understand the impulse to find these magic bullets — it’s exciting, it’s sexy, it’s all those things — it strikes me that much progress if not most throughout history has really been a series of incremental gains. (Stephen J. Dubner, Freakonomics Podcast: In Praise of Incrementalism)
Miracles, by definition, are rare and probably impossible. That’s not the kind of solution you can count on when you need it. The chance of the instant win is too unlikely to rely on. When it comes to your health, you will that see bigger changes happen over time in a series of small steps.
We devote vast resources to intensive, one-off procedures, while starving the kind of steady, intimate care that often helps people more… We have a certain heroic expectation of how medicine works. (Atul Gawande, The New Yorker Annals of Medicine: The Heroism of Incremental Care)
Dr. Gawande explains that, after World War II, the use of penicillin cured bacterial infections so well that it was like finding out that water could put out fire.
We built our health-care system, accordingly, to deploy firefighters. Doctors became saviors. But the model wasn’t quite right. If an illness is a fire, many of them require months or years to extinguish, or can be reduced only to a low-level smolder. The treatments may have side effects and complications that require yet more attention. Chronic illness has become commonplace, and we have been poorly prepared to deal with it. Much of what ails us requires a more patient kind of skill… Incrementalists focus on the course of a person’s health over time—even through a life.
What matters most is that sustained progress is made over the long term, not only in the moment. We must seek to recognize problems before they happen and prevent them by staying vigilant and adapting our approach. While we can’t predict everything or prevent every problem, we must do our best to see what we can achieve together. Even though we don’t know exactly when the change will happen, we must keep working to achieve our goals.
The highest-paid medical specialists are those who intervene in a difficult moment, such as surgeons. Primary care physicians, working to bring about better health gradually through routine care, are paid less. The problem is that our health care system values the incremental approach less, even if the benefits are greater in the long run. Let’s decide to value incremental care more. Together we can shape the future, one step at a time.