F. Scott Fitzgerald, author of The
Great Gatsby and considered by many to be one of the greatest writers in
American history, has a quote that I’m reminded of fairly frequently:
“The test of a first-rate intelligence is the ability to hold two
opposing ideas in mind at the same time and still retain the ability to
function.”
It’s debatable whether it takes “first-rate intelligence” to hold
opposing thoughts, but there’s no doubt that each one of us takes in all the
information life throws at us each day, and then we try to create simple rules
that make sense of the complexity that surrounds us.
When we generalize, we’re trying to make things more shallow and
superficial. Even those of us who have chosen to specialize in one particular
area have the same desire for simplification. We want to believe that things
outside our specialty must follow rules similar to that which govern things
inside our specialty. Either way, the desire to simplify ignores the complexity
and nuance that makes up the world around us.
This desire has plagued science for generations. The first
scientists of the 17th and 18th centuries had to solve
simple problems such as what forces were at work when a cannon ball fell to
earth or why the earth rotated around the sun. Later in the 19th
century came the challenge of making reliable predictions about seemingly
unpredictable things like the movement of gas particles in a vessel or the
transfer of heat from one medium to another. But the problems of the last
century are complicated and defy simple rules and generalizations; things such
as how to pull oil from rock shale miles under ground, understanding how our
cells age or how our environment affects our bodies. These are problems that
have and continue to require thousands of the brightest minds working millions
of hours on ideas that are complicated, nuanced and bring together people with
perspectives that are often directly opposite one another. This is science in
2015, and no branch of science demonstrates any more nuance and complexity than
medicine.
Here’s an example. Today, for our organization to sustain itself,
we must do two things simultaneously that seem at odds with one another. We
must grow and reduce our costs and do so in an environment that is extremely
complex. Growth is necessary for us
to reach an economy of scale and maintain a full complement of sub-specialty
care that our 459,000 patients need. At the same time the government, insurers
and companies that pay for our services have shown us that we must lower our
costs without compromising quality of the care if we expect them to choose
Mercy as their provider. Meanwhile we must make certain that our 11,000
co-workers are paid competitively; and have opportunities for growth and
personal accomplishment; and make sure we are in compliance with federal, state
and specialty certification; and make sure our quality of care doesn’t slip;
and reinvest in our hospital and clinic infrastructure; and come up with
innovative ways to provide better care; and support our community with time and
philanthropy; and well, you get the idea.
