When [disease] Can't Be Stopped, That's Where

Culture Matters. Of Course, If Physicians Are Rewarded Or Penalized For Their Service And Results, The Culture Will Change. But The Key Values We Doctors Are Being Pressed To Embrace Are Humility, Teamwork, And Discipline.

We Recruit For Attitude And Train For Skill.

The Big Thing That's Happened Is, In The Time Since The Affordable Care Act Has Been Going On, Our Medical Science Has Been Advancing. We Have Now Genomic Data. We Have The Power Of Big Data About What Your Living Patterns Are, What's Happening In Your Body. Even Your Smartphone Can Collect Data About Your Walking Or Your Pulse Or Other Things That Could Be Incredibly Meaningful In Being Able To Predict Whether You Have Disease Coming In The Future And Help Avert Those Problems.

In The End, People Don't View Their Life As Merely The Average Of All Its Moments-which, After All, Is Mostly Nothing Much Plus Some Sleep. For Human Beings, Life Is Meaningful Because It Is A Story. A Story Has A Sense Of A Whole, And Its Arc Is Determined By The Significant Moments, The Ones Where Something Happens. Measurements Of People's Minute-by-minute Levels Of Pleasure And Pain Miss This Fundamental Aspect Of Human Existence. A Seemingly Happy Life Maybe Empty. A Seemingly Difficult Life May Be Devoted To A Great Cause. We Have Purposes Larger Than Ourselves.

As Economists Have Often Pointed Out, We Pay Doctors For Quantity, Not Quality. As They Point Out Less Often, We Also Pay Them As Individuals, Rather Than As Members Of A Team Working Together For Their Patients. Both Practices Have Made For Serious Problems.