Friday, January 13, 2012

The Funny Thing About Limits

As any healthcare provider knows, it's imperative to know where on the continuum of care we stand in our abilities.  We must know our limits and weaknesses.  It is impossible or at least unethical for an untrained family physician to probably perform a craniotomy.  It is impractical for me to think I can be Indiana Jones and go on "save the world missions" if I am ill prepared and if my toolbox of skills is not adequate for the setting.

We are brought up thinking we all have limits.  It is "common sense."

But, as my senior prom date, Joel, said in his Impossible Manifesto, "The funny thing about limits is that they're not real."

When is the right time to understand your limits, and when is the right time to forego them and understand they are for the most part arbitrary rules?  Limits might just be temporary and things we can overcome.

Does it mean we don't have weaknesses? Absolutely not.  As a matter of fact, I think it might be our ability to admit our weakness that decrease the limits in front of us.  When we know our weaknesses, we know we can ask for help, and we can become twice as strong against a barrier. 

In the healthcare system, there are many rules, policies, and limits in place that are meant to protect patients, and for safety reasons, we ought to abide by them.

But often, limits are not put in our way in order to give optimum care.  Rather, limits are often outdated and create barriers for innovation.  Limits put a stop on both brilliance and destruction, but are not adequate in telling the two apart. If we are on the brink of an idea and of greatness, who's to say we should follow the rules?  Otherwise known as red tape, this obsession with rule making and limit creating is paralyzing growth and creativity to solve problems.  The Millenial Generation of physicians is coming and has brilliant ideas.

We believe, collectively as a generation, that we can do anything.  We can even fix the mess that greed has created, if only we don't believe in the limits our predecessors have set before us.  We must learn the rules only so we fully appreciate their complexity, and how to delicately break them.  We need to get inside so we understand how to transform limits into open windows of opportunity.  When someone says impossible, we must automatically, and without hesitation, think, definitely possible: I just need to get creative.  Change is possible if people can change, and people CAN be swayed.

Things have to change if we're going to sustain ourselves on the planet.  It's scary to think people believe that rules and limits are absolute.  They're not. 

Certainly there are algorithms and evidence-based procedures to follow, but we must discern where the root of it comes from.  Algorithms are evidence-based and tested for patients' benefits where most rules and policies are not tested.  They have not gone through a randomized double-blind control study, so who's to say the rule is right? If it's man-made, it's not absolute, and another man can come along and make a new rule or change the old one. Man-made rules mean nothing unless they have been tested for efficacy.  But then, they are not really rules.  Instead, the logarithm reaches the threshold of existence or reality by becoming a part of science.  Outside the realm of science, we must ask ourselves where did this rule come from?  Who is this rule benefiting? Is it truly benefiting a patient, or is it benefiting someone's bank account and is limiting efficiency and change?

The funny thing about limits, is that if we truly understand their roots, we will understand that they simply do not exist.  That statement plays on the premise that existence requires more of a sense of permanence and truth rather than arbitrariness.  Limits are not truths or even discrete principles.  They are merely obstacles for us to get where we want to be.  For more on this, I highly encourage you to check out Joel's newest post on the Blog of Impossible Things regarding Bullsh*t Qualifications.  Limits are often Bullsh*t and he argues that qualifications are often the same. 


  1. Hey Vicki!
    I've been reading your blog posts and find them to be very interesting. Regarding this one, have you read Practical Wisdom by Barry Schwartz? It mainly discusses the barriers and rules found in education, law and healthcare and how these impede a professionals' ability to exercise and practice what they feel is best for students, clients, patients, etc.

    Great work on the blog :)

  2. Hey Erica,
    Thanks so much for reading. I haven't read it but will definitely check it out! Say hi to the crew for me if you're around Newark!