Paul Farmer-The need for “systems thinking” in health care


– You can’t be involved,
I don’t think, in medicine and be a luddite. You can’t be against tech– You can’t have this balkanized view that Jeff said was bad. It’s bad for social change, it’s bad in the social sector, it’s bad in medicine and public health. To believe that everything
is a competition between scarce resources is going
to doom a lot of the work that Jim has worked on or I would work on or many of us work on. It will doom it to failure
to have that kind of– We need just as much in global health, for example, that commitment to the bigger vision. And you asked me what that was but I just want to say, I feel that what I’m saying is really
echoing what Jeff said. He said, “Green is green”.
I understood the metaphor. Actually, Harvard’s pretty savvy. They have quite a,
(laughter) Harvard, they have a slogan there that I see at the medical
school all the time. “Green is the new crimson.” (laughter and clapping) Here, it’s just “Green is
the new green.” At Dartmouth. But, I think where we’re going
is, again, systems thinking. In medicine, the interaction
with an individual patient, whether that be in Haiti or at Harvard, You need to be attentive. You need to be listening to
what patients have to say. But if you can’t take
that individual experience and put it into an interpretive grid that is really systems thinking
and drawing on the evidence, then you’re not doing
your patient a service. You could be the most
compassionate person in the world, but if you don’t know the literature, if you don’t know the data, if you don’t know what’s
gonna help that person in terms of prevention,
diagnosis, or care, you’re going to do a
disservice to the patient. I see global health the same way. If we cannot apply systems thinking to– this is why, as Jim said, we asked Mike to spend time with us in rural Haiti. We said, “Go to the clinics.
See how this is done. “Help us find ways of doing it better.” And that’s really the future
of a lot of these initiatives. And I’ll give one specific example: If we fight for an idea and that idea, the grand idea
is, let’s say, social justice. Equity, fairness, whatever you call it. Some of these words are sort of tarred, inappropriately I might add. But, it’s fine to say social justice. The idea that people deserve a fair shot just because they’re humans
and they’re on the Earth. You take an idea like that and let it drive forward a program. And Jim has been a master at this in my experience working with him. The implications of saying well, you know, it’s not a good idea to say you can’t treat cancer in rural Rwanda. What if cancer’s a big
problem in rural Rwanda? It is, by the way. So
that’s not the good idea. No, we need an idea that
everyone deserves a fair shot. Then you apply systems thinking. How can we bring down prices because of pooled procurement? Jim taught me a lot of these
things back in the early ’90s. And that’s a specific example, talking about cancer prevention, diagnosis, and care in rural Africa. A lot of people who are constrained by this idea that we have
very limited resources. How many times do you
think I hear, in the course of a single week, “But
we’re living in a time “of really constrained resources.” And what I’ve tried to do is learn how to say rather cheerfully, cheerfully mind you, that’s another trick. Ruth, how did I do? – Good.
(laughter) – Cheerfully, “Yes that’s true, “but they’re less constrained now “than they ever have been
before in human history.” So, what is the new
strategy to drive forward the big idea, which is
equity and social justice? What are our strategies to make this a systematic
approach to these problems? That’s the big future for global health. And I’ll just say, to link global health to
social justice movement we’re gonna have to also get together with those environmentalists
Jeff didn’t like. I’m kidding. I bet you
like them now, don’t you? Green is green? (laughter) So, that’s–
– There are many things I’ve learned as I’ve aged, Paul. I’ve mellowed a little. – Bringing together
these two big movements in my line of work. This happens a lot in
universities and colleges. You bring together the
social justice movements. People talking about fair trade and, you know these are young Americans, they care about this stuff. And then, bring that
together with the movement for environmental justice and,
you know, saving the planet. That’s gonna be where
things are gonna go forward. And just avoiding this
balkanization and saying, “If I profit, he or she will
not profit.” That’s not true. Any doctor working like we
do, in places where we do, know that people will be
sick if they don’t have jobs. And they can’t have jobs if we
don’t have a vibrant industry and growth beyond the sectors
that we might work in. So, I think that that’s
where this is moving forward is a less balkanized view of the world.

One Reply to “Paul Farmer-The need for “systems thinking” in health care”

  1. As a person who majored in Business and Computer Information Systems, I see many systems analysis review techniques could be very helpful in making heslth care more efficient for all of America. Helping more patients receive quality and compassionate health care while increasing the speed at which information is available to medical providers and patients for health medical and billing information will reduce the costs involved over the long term.

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