By Dr. Alan G. Thorson
In a straight-talking Presidential Address, in which he was as likely to quote a plainspoken native American Indian chief as an eloquent literary don, outgoing ASCRS President Dr. Alan G. Thorson exhorted his listeners not to accept mediocrity in medicine and decried "a disturbing and subtle trend in the way medicine is being treated today."
The disturbing trend is not just in medicine, according to Dr. Thorson: "It is a sickness in society as a whole. It creeps up on you unexpectedly. It corrodes your stamina. But now we have identified it, so we need to heal it."
What is it? "It is this misdirected desire for equality that suppresses diversity rather than focusing on equal opportunity that celebrates diversity." He had begun by saying, "One of the greatest joys of the practice of medicine is the opportunity to experience diversity in human life…in all aspects of life."
He explained: "One very stark element of diversity that is poorly understood is that of economic diversity…We all live in relative poverty compared to those on the economic ladder above us. But absolute poverty is real, not perceived…and unacceptable…as should be health care poverty."
"Outliers," in the sense of individuals or activities that fall outside the curve, is a word that Dr. Thorson used often: "In medicine, we strive to be the outliers on the top of the curve….and I believe…that a fire to achieve does burn…a desire to excel, flares…not just in medicine but in most individuals in whatever they do…It's called pride of place or first position…the desire to improve…to be the best of class."
Dr. Thorson focused on three examples of the disturbing trend that suppresses diversity: the issue of work hours, the Affordable Care Act, and the tort system of medical liability.
On work hours, he urged consideration of "modern fatigue risk management strategies" in place of "the application of one-size-fits-all ‘hours of service' regulations." Studies have shown that some people harbor "resilience" to sleep deprivation, while others have "vulnerability." Dr. Thorson's suggestion: "To be fair, shouldn't we use these models to predict both ends of the spectrum, so that our residents can be allowed to fully utilize their own skill sets and natural traits while protecting patient safety?," he asked.
After listing 11 fees, penalties and taxes that will be imposed by the Affordable Care Act and tend to consolidate the curve and force everyone to the center of mediocrity, Dr. Thorson focused on the tax on high-cost insurance plans, also known as the Cadillac tax. "A 40% tax on a higher level of health care will simply put such care within reach of only the very wealthy and squelch those on the cusp of reaching the next level of excellence as they might measure it for themselves," he said.
Even a cursory review of data on the tort system for medical liability shows "the current system is costly and matches injured patients with deserved compensation poorly," he said. Sixty-five percent of medical liability claims are dropped, dismissed or withdrawn. Another 25.7 percent are settled, and 4.5 percent were decided by alternative dispute mechanisms, and 5 percent went to trial, where the defendant (the medical practitioner) prevailed 90 percent of the time.
"Medical liability reform could play a leadership role in making our entire tort system more responsive to the needs of society as a whole…The system as it stands is a failure to our patients and a clear case of mediocrity at best. We need to instill some diversity into the system with new, bold ideas for reform based on appreciation for the goals we want to achieve," Dr. Thorson declared.
"It is unfortunate that outliers at the top, those to the right of the curve, are naturally balanced by outliers at the bottom, or those to the left of the curve…But consolidating the curve is not the way to solve the problem of the bottom outliers. Too tight a consolidation of the curve breaks the spirit, suppresses imagination, stamps out ingenuity, crushes hope and enshrines dependence. Without hope, economic diversity cannot prosper, and, as in all of nature, loss of diversity leads to degeneration of the species or, in the case of economic diversity, loss of ambition," he said.
"You must do all you can to maximize your contributions to society based on your skills and abilities," he told his fellow colorectal surgeons. "Do not accept mediocrity but do accept your responsibilities to those who have not achieved the same level of success…whether by bad luck or bad choices…and to those in absolute poverty and health care poverty. Keep in mind that none of us have walked alone to where we are," he added.
Dr. Thorson closed with words he attributed to a grateful young man he served on the Pine Ridge Indian Reservation in South Dakota: "When you are born, you cry and the world rejoices. Live your life so that when you die, the world will cry and you will rejoice."