Chapter 2: Who will set my VCR clock?

The power went out briefly at my Dad’s house today. He reminded me of the era when he would have to find a youngster like me to reset all the digital clocks in the house after the power went out. Sometimes the clocks flashed 12:00 for a long time. It’s not so easy to merge with a new paradigm.

My book consultant, Kristina, can relate. She came late to the smart phone party. Her teenage son finds it pretty funny when she punches the “keys” on the touchscreen harder when the smartiephone isn’t cooperating. Clash of the paradigms.

Piaget’s learning theory applies here. How do humans adapt to new stuff? His theory views intellectual growth as a process of adaptation or adjustment to the world, and it isn’t linear. It occurs in discontinuous leaps or breakthroughs.

Three processes are involved: assimilation, accommodation, and equilibration.

Assimilation is using the existing schema or paradigm to deal with a new object, situation or information.

Accommodation occurs when the current paradigm doesn’t handle the new object, situation or information and needs to be changed to deal with it.

According to Piaget equilibration repeatedly causes development to occur in a series of discontinuous leaps or breakthroughs. There are long periods where the child’s schema (paradigm) can deal with most new information by assimilation. But an uncomfortable stage of disequilibrium occurs when the child’s paradigm can no longer deal with the new information. This discomfort creates a drive to master the new information and restore balance. Thus accommodation causes a breakthrough into a new paradigm or worldview that can handle the new information. The new information is acquired and the paradigm shifts in a dramatic breakthrough into a higher level of cognitive or intellectual development. Then the process of assimilation resumes inside the new paradigm until the next time the child’s schema needs to be adjusted because of unworkability and discomfort.

As adults this process doesn’t always continue. Sometimes you get stuck. You become an assimilator. As an assimilator you make new information fit what you already “know.” This involves rejecting stuff that doesn’t fit your view of "the way things are." If you’re an assimilator you aren’t referred to as open-minded and you would not have gotten on the Niña, the Pinta, or the Santa Maria. You would have said, “No, thanks, Chris. You have a nice trip. We’ll take care of your wife and kids.” No new world for you.

In accommodation you alter what you “know” when you come across new information. You would be referred to as open-minded (or gullible if an assimilator is talking about you) but guess what? New world for you.

Modern medicine is an assimilator. In medical school we are apprenticed into the tradition of diagnosing and treating illness. Tradition and science are antithetical. Tradition says, “This is the way it is done.” Science asks, “Is it true?” As the French philosopher, Michel Foucault, pointed out there is in medicine a dominant mode of discourse and that which is outside the prevailing view is marginalized, repressed or ignored. And we have the most expensive, ineffective and deadly healthcare system in the world. It isn’t because we know what we are doing. But you can't tell us that. Nobody knows more than a doctor.

Do I care about Obamacare? Not really. That dog, modern medicine, won’t hunt. The system will fail no matter what. There’s only so much money you can throw at a dog that won’t hunt.

A new paradigm is coming but the providers aren’t going to change. As the physicist, Max Planck once said, "A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it." It’s the same in medicine. One day people will stop going to doctors who keep applying old, unworkable paradigms and telling stories about how truly hard it is to get a VCR that is flashing 12:00 to stop doing that. They’ll go to a new breed of doctor who lives out of a new paradigm that has power and mastery with regard to health and well-being. Perhaps in the new paradigm “patients” won’t even go to “doctors” save for trauma and acute infection. Physician heal thyself.