No One Is Smart When They Don't Think

This was a line I used with my sons, particularly the eldest, for some reason. "You're a very smart boy, Jonathan. But no one is smart when they don't think."

One of the smarter social workers in our department made a stupid comment that can only come from not thinking. This is a witty and urbane man, with whom I have had several pleasant conversations. We were being instructed in the proper way to write the address on a revised form: should we use the physical address, the mailing address, the guardian's address, or the place we are bringing the patient? Whenever a form serves more than one master questions like this rise to the surface.

As is usual, several of the social workers could not understand the explanation, and the attempts of the department head and others to find the magic words to make it clear weren't forthcoming. There are a few dim people, always the same ones, who cannot drop their previous idea and accept a new one. They always have to attempt some synthesis of the new idea and the old one. This can be disastrous.

The social worker who made the stupid statement was not one of the dim ones. He was one of the ones who got the new idea right away and was attempting to explain it to others. But in the frustration of the idea not getting across, he blurted out "I would just like to say that this is a good example of why we need a new health care system in this country." No, you bufflehead, this is precisely the sort of thing that will become worse. A description of a new regulation requiring that a form be given twice during a patient's stay, once at admission and once two days before discharge only solidified the obviousness of this. The idiots who made up the form and the regulation would now be in charge of more things, not fewer.

Every intervention solves some problems and creates others, though it is always possible for a bureaucracy to create problems and solve nothing. If we go to a Canadian/British system of health care it will solve some problems and create others. If we go to a French or German model we will solve different things and create different problems. If we change nothing we will continue to have the problems we are having, but we will avoid getting new ones. In all discussions about complicated and enormous problems with competing needs, we will get some benefit and some loss. Anyone speaking as if there will be all gain and no loss is not thinking. We do have problems. Solving them would be good. The question then becomes, does this plan solve more things or worsen more things?

Such evaluation is not beyond this particular social worker. The evidence is right in front of him. But he is convinced for political reasons that we need to change health care by guarranteeing more of it via government, and so whatever problem comes up, that's the automatic, reflexive solution.

No one is smart when they don't think.