Thursday, July 26, 2007

Paint By Numbers

I remember my fascination with colors in art class.

I was painting with primary-color watercolors and would watch the myriad of colors created as the colors were allowed to blend: subtle shades of every color in the rainbow. Then, as if magic, a stroke of a clean brush containing water passed over the colors would cause them the streak and fade to the point where the color was no more – a graduated fade to white again. Where did one color end and the other begin? It was impossible to tell precisely.

True artists knew the power of subtle shades of color – they highlighted, shaded, rendered visible that which was previously invisible, and conveyed subtle, but important, messages to the viewer. It is the ability to work with these media in subtle and creative ways that brought life to the work and defined the great masters of art: Rembrandt, Cezanne, Renoir, for instance. These subtleties evoked emotion.

In the fifties, Paint by Numbers took hold, promising to make “Every Man a Rembrandt.” Anyone could place the pre-mixed paint colors and render a recognizable colored picture just like the next person. It was art for the masses.

But the pictures appeared flat when finished. Fine shades and subtle hues with their gradations were lost and made for poor renditions of the intended image. Appropriately, none of these paintings ever made it to the Louvre or other great art museums. And the poor soul that devoted countless hours to filling in the little numbered areas on the white paper with the pre-defined colors knew that the finished product never looked as good as they hoped.

Medicine, regrettably, is becoming paint by numbers.

We even now are beginning to try to determine when someone is just about dead - by numbers.

Follow the potassium – by numbers.
Follow the white count – by numbers.
Diagnose a heart attack - by numbers.
Determine the quality of the care delivered – by numbers.
Develop a medical record – with numbers.
Determine the quantity of patients to see – by numbers.
Determine time to see each patient – by numbers.
Survey the patients’ satisfaction – with numbers.
Determine the quality of the doctor – by numbers.
Determine productivity – with numbers.
Protect your ass from litigation - with more numbers.

And pre-defined critical pathways, now an integral part of medical care and quality assurance initiatives, are supplanting independent thought.

But can numbers quantify handling of tears after a diagnosis of cancer is delivered?

Will numbers find the rare diagnosis?

Can numbers quantify the skill of the surgeon who spends hours in an operation creatively reconstructing a new route for GI contents to travel after a tumor is resected?

Can numbers quantify a smile? A touch? Or an emotion?

* * *

“How’s she doing?”

“Her respiratory rate is 28.”

“No, how’s she doing?”

“She’s pissed that the specialist didn’t get by to see her today and she wants to sign out Against Medical Advice.”

* * *

Now I ask you, which paints a better picture?


1 comment:

Lisa said...

Spot on, Dr. Wes.