This was one of the responses to the post about Upside down medical hierarchies:
Why would that sort of thing be needed? Of all the things to change in Medicine, not sure the hierarchy is one of them.
This comment reminded me of a line from James Clear’s book, Atomic Habits:
“…the only self-improvement strategy that makes any sense is to focus on what you can control.”
And one of the most important things we can control, is our willingness to try things that might not work, in pursuit of uncovering the breakthroughs that transform everything.
But alongside that is the reality that hierarchy is about deciding the rules of how the game is played.
No matter how well you think you can play the game, the real winner is whoever creates the rules of the game.
Hasbro has won every game of Monopoly ever played since 1991…because they are in control of how the game is played.
But relating this back to Medicine, experimenting with hierarchy is to experiment with how the game is played, rather than simply recruit more players to join the dysfunctional game that’s already being played.
How would it change things if a lower tier Medic had the chance to leapfrog a seasoned Medical consultant?
How could it change things if Junior Doctors got paid from a global healthcare blockchain based on their MedicRank, and not based on political clauses in “The Contract”?
What if you were paid to go to Medical School, but had to practice Medicine for free as a vocation?
What if the only people allowed to practice Medicine were those who were financially independent and didn’t need to be paid for their work as a Medic?
What if we rewarded Medics (Nurses, Pharmacists, Doctors etc) based on how much of their humanity they brought to each interaction with each patient?
“What if” questions like these are at the heart of reimagining how the game of Medicine could be played.
And experimenting with hierarchy could be just the thing that unlocks the brilliance and creativity of all the Medics who are being squandered by the current system.