Rene Descartes (1596-1650) is said to be the “original modern philosopher”. This puzzles me as there are novel thinkers of his time who were thoroughly more modern, some you are familiar with (Baruch Spinoza), some you possibly have never read (Pierre Bayle).
Descartes’ signature “Cogito, ergo sum” (I think, therefore I am) capsulizes his mathematician’s heart – an attempt to sweep away all doubt and uncertainty that had crept into 17th C Western philosophy via Epicureanism, Stoicism, Pyrrhonism and the like. But Descartes’ famed maxim is flawed,….it would be better stated as “Dubito, ergo sum”, i.e., I doubt, therefore I am.
Descartes, a religious person, unwittingly paved broad faith in Reason, as opposed to Reason-ing. True faith in the creed of Reason devolves to abstractionism and analysis, which is more properly called Rationalism (Jacques Barzun). This is a useful distinction,.….Rationalism enhances the welcome technological developments of medicine, travel, housing, food production and such,…..yet when unchecked by Reason-ing, we cultivate consumerism, production of weapons of mass destruction, environmental degradation, alienation, anxiety and such.
USA healthcare – unrelenting abstraction, obscure micro-data analysis, endless delves into ever-narrower splices of what it is to be human, wider separation of mankind from Nature, i.e., homage to the deity Rationalism. Versus the blessed sun king Reason-ing, i.e., emphasis on our ability to sift and sort with fluidity, determine what is false (not prove what is true), value beauty, compassion, and flux, treasure Now (not Then, not If Only), test with humility and restraint, recognize the easy misconceptions of cause-and-effect…..
Perinatal Quality Collaboratives (attached review) have many virtues,…..are largely following the Institute for Healthcare Improvement Model and Vermont Oxford Network exemplars,…..and are documenting encouraging progress as King et al note. While reading their article I thought of George Orwell’s 1984 prescience – “Who controls the past controls the future; who controls the present controls the past.”
My version – Who nurtures the fetus/child nurtures the adult; who nurtures the pregnant woman nurtures the fetus/child.
Also, would it not be productive if the PQCs would develop a composite score to drive benchmarking? That is, a risk-adjusted metric that objectively summarized how an obstetric service was delivering quality, safety, and value,………a summation of: a) mortality, b) cesarean section rate, c) postpartum hemorrhage, d) hypertension management, e) opiate use, f) elective delivery before 39 weeks, g) appropriate antenatal corticosteroid use, h) prevention of GDM, i) and breastfeeding rates……?
Joe Kaempf, MD
District VIII Oregon Representative
Portland, OR
Volume 12, Number 46