Tim Jackson has written a fascinating piece about the economic limits of productivity. Aside from the economic considerations, I increasingly believe that the philosophy underlying medical care is incompatible with the concept of productivity.

It’s Father’s Day. My Dad is gone, but not his impact. 

“In a time of universal deceit, telling the truth is a revolutionary act.”

(George Orwell)

"It is good to have an end to journey toward, but it is the journey that matters, in the end."

(Ursula K. LeGuin)           

I used to dream about a new pair of cross-country skis for a season, evaluate different options, wait for a bargain, then purchase an expensive pair, and finally spend hours prepping the bases. Having invested so much time, money and effort in the skis, it seemed natural to do everything in my power to preserve them. I waxed and scraped them repeatedly, stored them carefully between uses, and skied carefully to avoid rocks or other hazards. In fact, I respected the value of the skis so much, I only used them in perfect conditions.

“…it’s easier to add stuff than to take it away.  It brings to mind thesecond law of thermodynamics in physics, which (very loosely) says that a system will always develop greater disorder (or randomness, or “entropy”) unless work is done on that system.  Stated from a clinical point of view: unless we invest more time and energy in our patients, their care will become more scattered, disorganized, and chaotic.”

"Vision is not enough. It must be combined with venture. It is not enough to stare up the steps. We must step up the stairs."

(Vaclav Havel)     

The German philosopher Hegel said, “We learn from history that we don’t learn from history.”

Life must be understood backward. But it must be lived forward. (Soren Kierkegaard)