The Corean Chronicles
Life by the Numbers
I'm old enough to recall when one of the fads sweeping the country was "paint-by-the-numbers" kits, where anyone could produce a reproduction, at least of sorts, of a famous artist by simply matching the number on a tiny jar of paint with the number printed on a cheap canvas stretched across cardboard and dabbing each number with the correspondingly numbered paint.
The older I get, the more I'm seeing our society structure itself along similar lines. It seems like everything is analyzed "by the numbers" and then either quantified, evaluated, or replicated... according to the numbers. Vital services -- such as medical care, road and highway maintenance, public safety, and education -- are evaluated in terms of their cost-effectiveness for populations as a whole. The problem is that all too many people and situations don't fit the numerical models. And numerical models seldom result in excellence, any more than paint-by-number kits resulted in great paintings.
In education, students' futures are effectively being determined more and more by standardized tests, and teachers' effectiveness is being measured more and more by the performance of their students on those tests. Besides the problem that there are students who test well beyond their real-life abilities and those who test below their potential, and the corruption of the system into teaching to the tests, there's the even larger problem that the tests are designed to measure the ability to succeed in "intellectual" settings and occupations, and there's also a tacit assumption that the abilities measured by those tests are the only ones that count. Now... I confess. I'm one of those who did well on tests, and to the test-designers and analyzers, I'm proof that the tests "work." At what? Such tests are excellent at identifying a set of skills useful for perhaps ten percent of the population. twenty percent at most. And what about all the others?
I'm sorry, but, as well as I may test, you don't want me trying to repair your leaky faucet, or your home wiring. I'm a good painter and a barely passable wood-worker, but keep me away from the mechanical side of your automobile or almost anything else. Yet the numerical, test-taking educational experts are acting as though it only takes people like me to run everything in society, because, by acting as though their tests measure all that is important, they effectively ignore those who don't fit in a narrow numerical model.
I'm more than happy to pay experts in fields other than those I know... but experts like that are getting harder and harder to find. The problem is that, in our zeal to evaluate education "by the numbers," we're not steering those students who aren't "intellectually" inclined to fields in which they could be both successful occupationally and financially. We're treating every one of them as either intellectual successes or failures, because that's what the numbers say.
In medicine, the numbers pressure for cost-effectiveness by the government and by insurers has resulted in fewer and fewer doctors who going into "general" or family practice, and those who do end up being pressured into seeing more and more patients for shorter and shorter visits... just to pay the costs of modern high-technology medicine. Reports are coming in showing that, in community after community, doctors are limiting the number of Medicare patients because the combination of excessive paperwork and low-mandated reimbursement results in their losing money on such patients... and in fact the inflation-adjusted real earnings of "family doctors" are declining, largely as a result of cost-effectiveness measures developed by the numbers and imposed on medical general practitioners.
On the other side, as I've noted in a different light in earlier blogs, the emphasis on financial success, by the numbers, has played a significant role in the housing/credit/mortgage melt-down, because almost everyone in the financial sector was focused on maximizing short-term yields and returns. Call it high finance by the numbers.
From the media to elite institutions, more and more, those lauded publicly are those who have been financially successful or who have been so and donated large sums of money, not necessarily those whose contributions to society cannot be easily quantified. Bill Gates is a figure known-world wide, because of the staggering "numerical success" of MicroSoft, but I can't even recall the names of the men whose pioneering work in transistors at Texas Instruments made that success possible, and I doubt most Americans could.
All this emphasis on the numerical and quantifiable neglects some very basis aspects of life and society.
No student was ever touched -- or inspired -- by a number. No patient was ever healed by a number. No criminal was ever physically apprehended by a number. No fire was ever extinguished by a number. But excessive emphasis on numbers -- from the stock mania of the 1920s that led to the Great Depression, to the body counts in
I agree with most of your essay, but the above statement is not correct. The federal government has been exerting financial pressure on hospital-based resident training programs to decrease the numbers of positions in specialty fields and increase them in 'primary' medicine fields: pediatrics, family practice, internal medicine, and (via intense lobbying by OB/GYN groups) obstetrics & gynecology. Medical students have been fighting this pressure (with some success). Few physicians want to go into primary care because medicine has gotten too complex for generalists. The recent trend is to increase the percentages of specialist physicians. This can be economical because they handle the complicated patient issues and let employed or affiliated physician assistants and nurse practitioners handle the simple tasks. This can save money, because the PAs and NPs bill less than physicians and because the specialists can diagnose and treat the difficult cases faster than generalists.
: 11:50 AMI have four children that we put through several educational systems. We made it a point to talk to the schools, ask which were the best teachers, get our children into those classes. We volunteered in their classes and tried to help the teachers and the schools with paper, pencils, books, and wrote letters of recommendation for those teachers that inspired, not just taught. You picked the right word there. We even home schooled for awhile as the needs of the child outstripped the educational system. We were one of a very small minority.
The other side of the educational system is one that few talk about. How to use it. I know a lot of people who have little schooling, but use it to the hilt, successful in all they do. I also know a lot of well educated idiots. How do you measure that?
Now, what can we do about it?
I absolutely agree with this. In the ICU, I look at numbers all night long, but those numbers are meaningless trivia without being able to put an eyeball on the patient. Humans defy the expected norms regularly, numbers that would indicate a crisis in one person might be the baseline normal for another.
Or as a very wise nursing instructor once told her large class of bright-eyed nursing students, "I agree, the textbook doesn't agree with your findings. The thing is, the patient didn't read that textbook."
On the specialist versus generalist debate, I come in one the side of specialization. The medical body of knowledge is incredibly vast, and complex. A generalist runs the risk of missing minor, but important details or research and thusly sets up a situation that could fail to treat the patient, or even harm the patient. That's a lawsuit waiting to happen.
Even in nursing, specialization is becoming the norm. I have enough generalized knowledge to have some idea of what to do in any given situation. (Or at least, I know who to ask and where to look it up.) But as a cardiovascular specialist, I would still be out of my depth with a traumatic head injury patient.
The computer also doesn't distinguish the amount of time I spend with clients. I have one that requires 8-20 hours of concentrated time to get work ready enough to even go on interviews, another needs a 20 minute overview of our area and peculiarities, yet they both get counted the same as ticky marks in the system. Because someone, somewhere, wants to reduce our clients to numbers and statistics that fit neatly into a report.
So is it our obsession with the scientific method that makes us want to quantify everything? Or something else?
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