September 01, 2004

Hospitalize the Regulators and Doctors

Another Blog: the Gauntlet of Disgust

Disgust is adaptive: we tend to experience it when we encounter something that could be dangerous to our health. Ironically, many of the treatments we have developed to keep healthy disgust most people. We are dissociated from the practice of medicine and prefer to leave the gory details to the professionals.

But this has the drawback that when the techniques of medicine become debated in society, most people react with disgust and subsequent negativity regardless of their benefits. This is especially true for new biomedical treatments such as tissue engineering, that evoke horrific images while actually being far more humane than past reconstructions and transplants. But as policymakers get more involved in running science and medicine, their reactions (or their reactions to voter reactions) have more power. If we want to have medicine based on principles beyond distaste and fear we need to make sure policymakers know enough to distinguish between something messy but benign and something messy and malign.

In the slow conversion from perversion to everday medical practice people get used to a technique and learn to see it for what it is. The only way to speed up this process is more exposure: maybe we need to get anybody who seeks to regulate a field to regularly participate in its everyday practice? No need to make health-care politicians into doctors, but a schedule of regular participation. The same might go for other fields, be they schools or the military. At present regulators mainly visit their fields symbolically. But given the increasing complexity of most areas and the growing risks of abstracting away the core goals of regulation, periodic reality-checks might be not just fun or educational, but necessary. Of course, implementing this idea is likely to be resisted by most sides. But if we citizens delegate regulation and the actual running of many parts of our societies, we should demand the inclusion of additional feedback lines to reality.

In many ways this is the mirror image of citizen's deliberations, where citizens are selected to deliberate important issues and act as advisors/bridges to the policymakers. Here policymakers are placed in the organisations they regulate and made to experience the consequences of their policies. Hopefully they will bring back a better understanding of the realities of their areas.

It has been remarked many times by doctors that the experience of being hospitalized has changed their outlook of how they handle things: despite being in the same environment the switch between doctor and patient reveals many unexpected and suppressed sides of the system. Maybe a one week hospitalization should be a part of medical training, and regular visits necessary for licencing (this might also improve the tendency to under diagnose among doctors).

Posted by Anders at September 1, 2004 11:37 PM