Anecdotally Speaking

"The ceramics teacher announced on opening day that he was dividing the class into two groups. All those on the left side of the studio, he said, would be graded solely on the quantity of work they produced, all those on the right solely on its quality. His procedure was simple: on the final day of class he would bring his bathroom scales and weigh the work of the "quantity" group: fifty pounds of pots rated an "A", forty pounds a "B", and so on. Those being graded on "quality", however, needed to produce only one pot -- albeit a perfect one -- to get an "A". Well, came grading time and a curious fact emerged: the works of highest quality were all produced by the group being graded for quantity. It seems that while the "quantity" group was busily churning out piles of work -- learning from their mistakes -- the "quality" group had sat theorizing about perfection, and in the end had little more to show for their efforts than grandiose theories and a pile of dead clay. --David Bayles & Ted Orland, from "Art & Fear, Observations On The Perils (and Rewards) of Artmaking"

I love this story, not just because of what it has to say about art, but because of what it has to say about perfection and the pursuit of perfection, a subject germane to medical practice. I have written on the subject as it relates to expectations for flawlessness and it speaks to Voltaire's famous statement, "the best is the enemy of the good," on which I have also written.

In my opinion, medicine it is no different than the ceramics class. "Quality" medical care emerges when dedicated physicians are "churning out piles of work -- learning from their mistakes." Ironically, it is from the fruitful ground of error, that physicians produce their best, highest "quality" work, getting better and better as they learn more and more, refining and revising, modifying, changing and adapting. So then, I think, physicians must be free to make mistakes; they must be, in the words of Bayles & Orland, free to tap into their "ordinary (and universal) humanity."

Current trends in health care, however, tend to advocate just the opposite. They tend to overly focus on the elusive goal of the perfect outcome, error free, faultless, exact, precise and flawless in everyway. This would be the job of the right side of the ceramic class whose task was only to produce the perfect pot. However, what happens when you demand perfection as the only acceptable result? You get no result. Worse, as is the case in health care, you can actually get a decrease in "quality."

So, I say, let physicians be physicians. Let physicians "practice" medicine. Let physicians refine their "art," the "art" of medicine. It has been done so traditionally. Then, I say, you will see "quality," just as they did with the pot makers, free to be who and what they are, pot makers. Or with doctors, doing what it is they do and doing it well, getting better and better.

Why does this work? Why can it be trusted? From Bayles & Orland: "For you, the seed for your next art work lies embedded in the imperfections of your current piece. Such imperfections (or mistakes) are your guides -- valuable, reliable, objective, non-judgmental guides -- to matters you need to consider or develop further. It is precisely this interaction between the ideal and the real that locks your art into the real world, and gives meaning to both."

Therefore, this is what it means for me. I will never be perfect or practice perfect medicine and I will never try to. I will never expect to never make another error again (hah!). But I will continue to do what I have always done, and incidentally, it isn't what I was always taught or trained to do, and that is to take each "error" or "mistake" or "undesired outcome" as they occur and learn from them. I take them as the "seeds" and as the "guides," and next time I do better. In this way, I improve, I get good and I end up making really good pots.