Wednesday, March 12, 2014

Syria & Ukraine - Thoughts on Tribalism

Tribalism is in our nature.  Our default emotional inclination is to distrust that with which we are unfamiliar.   When humanity was living in isolated small groups, with no technology, subject to the whims of the environment, that inclination was necessary for survival.  When your tribe is barely surviving a stranger is a threat on many levels.  They may deprive your tribe of the resources you need to survive, or just outright kill you.  So whatever tribe recognizes the threat first and eliminates the strangers survives.

As humanity evolved that instinct evolved into forms of institutionalized discrimination against those who are different from us.  

Beginning a couple hundred years ago our ability to manipulate our environment began to make, for more and more people, the notion of scrimping for survival a thing of the past.  Here in 2013 we have the technology to feed everyone, to house everyone, to cloth everyone.

But our thinking lags behind our technology.  Even in the United States, where Tribalism was not well entrenched to begin with, and has been continually weakened by the influx of immigrants seeking to put that all behind them, we are only now finally getting to the point where Government, in word and deed, does not discriminate against people based on broad categorizations of personal characteristics.  Although our founding principal was that we are all created equal and entitled to equal treatment under the law, we had to fight a Civil War in which millions of citizens died and then amend the Constitution to clarify that the principal actually applied to all persons.  WW I and WW II both exploded out of tribalism, the sincere belief by some that other ethnic or religious groups were subhuman in some way.

To this day, 150 years after the Civil War, we in the US are still trying to clarify that "all" means "all".  Most of the world is moving, slowly, the same direction as the United States, particularly in Democratic states.  The exception is the Middle East.  The crossroads of the world has such a long history of conflict between competing groups that many folks there evidently have not yet even begun to realize we all do better through respect and cooperation.

Syria is the bleeding wound in Middle East that is exacerbating regional tribalism.  In some sense, like our Civil War, it may be a necessary and painful process that we cannot insulate the people of the region from.  But in our Civil War, we were largely left to sort it our ourselves.  In Syria that is not the case.  Russia and Iran, two purported democracies where powerful groups "who know best" have a monopoly on the democratic process, have been supporting the Syrian Government, whose power is based in Tribalism and patronage, for decades and continue to protect and support the regime.  Various other regional power brokers support one or another group of dissidents hoping to influence the outcome.

Now Russia is moving in the same direction in Ukraine.

So the stark choice for the US is whether we try to counter the influence of external power brokers to level the playing field so the people of Syria make the choice they will live with, and learn from, in the future, at the risk of sparking wider conflict?  Or do we stand by and let the folks with a tribal agenda prevent the people of Syria and Ukraine from living and learning from their mistakes.

Sunday, March 9, 2014

On Chosing Your Own Doctor

The notion of choosing your own Doctor has become a big controversy since Obamacare was passed.  Everyone is for it, the controversy is all about accusing others of not allowing people to choose their own doctor, implying (usually) that if you don't get to choose your own doctor you will end up dead.  It is silly.

Over the years I have from time to time been hired to do research that relates to he competence of doctors.   Here are some basic truths I have learned.  

1.  The competence of Doctors is controlled by Doctors (in California by the Medical Board) 

2.  Medical Science is full of gray areas, competing ideas, different views of treatment.

3.  In our privacy obsessed society it is very difficult to get information about the competency of a particular doctor, particularly doctors operating in a small or solo practice.

Put these three facts together and you have created the situation we have - where Doctors who are supposed to monitor doctors are extremely unwilling to judge another doctor to be incompetent.  Even when a patient dies at the doctors hands, other doctors are inclined to bend over backwards to give the doctor the benefit of the doubt.

As a result horribly incompetent doctors, doctors who have committed major mal-practice multiple times, including killing people with their mistakes, sometimes continue being doctors for many years, continue having patients and getting referrals.   

Who goes to these Doctors?  Who sends them referrals?  People (including other doctors) like you and me who judge them as we judge other people we meet.  Are they likable.  Well-spoken.  Friendly.  Do they sound like they know what they are talking about.

There is no way for a lay person to know if their Doctor is bad, mediocre or good.  Given the gray areas in the medical field, even fellow doctors who work with the doctor may have a hard time distinguishing good from mediocre.

As far as I can see there is only one way to make sure you don't get a really bad Doctor.  Use a big corporate entity for your medical care, who pays the malpractice insurance for all it's doctors.  We all know no corporation is going to tolerate an employee who costs them lots of money.