Curse of Compensation
Today, I will covering the topic of compensation. No, I am not talking about the pay that one gets which we all know ours is always too low. I am talking about the case where we adjust our approach to a problem as a method to overcome a deficit.
I read a story about a doctor comforting a widow in America the early part of the 20th century. He informed her that her late husband's Tuberculosis(TB) would have been diagnosed had an X-ray been done but the X-ray cost a princely some of money. To save the money, the doctor tried his best to use physical examination to find the root cause of the problem. The author of the story was grateful that the cost of X-ray has fallen significantly that most people can afford an X-ray to rule out infection of TB.
Sounds good and the case can be closed. And we can all move on to the next story, right? Not so fast. Today, doctors don't just have X-rays. They have tons of gadgets and a smorgasbord of tests to play with. We no longer have to trust the doctor's Mark 1 eyeball and primitive touch sensors to diagnose illnesses. We are talking western medicine here so I will not talk about smell and taste (In some culture, doctors do taste their patients urine.).
Unfortunately, one side effect of better science is that most doctors are not able to diagnosed an illness without the aid of technology. I am not talking about the obvious trauma cases. I am also not talking about simple cases which most doctors see on a day to day basis. I am talking about the illness that have physical symptoms that are not obvious. I am talking about illnesses that are found in the middle of the chapter or near the end of the medical textbook.
Doctors used to be able to study patients have a longer period of time in the past. In today costly society, patients turnover is so high that doctors spend minutes or hours with a patient instead of days or weeks. Don't forget a doctor can order blood tests for 100 patients (or if he is hardworking enough, perform it and check the result) before he finishes examining the same 100 patients. The downside is that efficiency has come at the expense of a good physical examination. Less physical examination time means less time for the senior doctor to have a teachable moment with the intern (aka houseman). Moreover, the interns (aka houseman) will only see the senior doctor using the time saving methods and then learn the "better" or even "only" method.
Now I am not just speaking off the cuff about this topic. On one hand, many people believe that physical examination is not obsolete and technology can take over. However, one cannot forget that many illnesses have similar symptoms and missing any crucial clues can lead one down the wrong rabbit hole. This is such a big problem that several doctors are now insisting that the medical students be trained on all the techniques of diagnostic medicine instead of the cool technological ones.
But enough about medicine. Even for governments, it is very easy to overcompensate. After War World 2, most developing countries were right fully worried that their young children did not get enough calories. The good news is that the risk of starvation has fallen noticeably but the risk of childhood obesity has gone up thanks to subsidies in basic foodstuff.
In conclusion, the laws of unintended consequences have a tendency to hit us when we least expect it. In most things in life, we have to conclude that more is not always better. And that most actions have a trade off.
I read a story about a doctor comforting a widow in America the early part of the 20th century. He informed her that her late husband's Tuberculosis(TB) would have been diagnosed had an X-ray been done but the X-ray cost a princely some of money. To save the money, the doctor tried his best to use physical examination to find the root cause of the problem. The author of the story was grateful that the cost of X-ray has fallen significantly that most people can afford an X-ray to rule out infection of TB.
Sounds good and the case can be closed. And we can all move on to the next story, right? Not so fast. Today, doctors don't just have X-rays. They have tons of gadgets and a smorgasbord of tests to play with. We no longer have to trust the doctor's Mark 1 eyeball and primitive touch sensors to diagnose illnesses. We are talking western medicine here so I will not talk about smell and taste (In some culture, doctors do taste their patients urine.).
Unfortunately, one side effect of better science is that most doctors are not able to diagnosed an illness without the aid of technology. I am not talking about the obvious trauma cases. I am also not talking about simple cases which most doctors see on a day to day basis. I am talking about the illness that have physical symptoms that are not obvious. I am talking about illnesses that are found in the middle of the chapter or near the end of the medical textbook.
Doctors used to be able to study patients have a longer period of time in the past. In today costly society, patients turnover is so high that doctors spend minutes or hours with a patient instead of days or weeks. Don't forget a doctor can order blood tests for 100 patients (or if he is hardworking enough, perform it and check the result) before he finishes examining the same 100 patients. The downside is that efficiency has come at the expense of a good physical examination. Less physical examination time means less time for the senior doctor to have a teachable moment with the intern (aka houseman). Moreover, the interns (aka houseman) will only see the senior doctor using the time saving methods and then learn the "better" or even "only" method.
Now I am not just speaking off the cuff about this topic. On one hand, many people believe that physical examination is not obsolete and technology can take over. However, one cannot forget that many illnesses have similar symptoms and missing any crucial clues can lead one down the wrong rabbit hole. This is such a big problem that several doctors are now insisting that the medical students be trained on all the techniques of diagnostic medicine instead of the cool technological ones.
But enough about medicine. Even for governments, it is very easy to overcompensate. After War World 2, most developing countries were right fully worried that their young children did not get enough calories. The good news is that the risk of starvation has fallen noticeably but the risk of childhood obesity has gone up thanks to subsidies in basic foodstuff.
In conclusion, the laws of unintended consequences have a tendency to hit us when we least expect it. In most things in life, we have to conclude that more is not always better. And that most actions have a trade off.
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