Shock and Medicine
shock…the shattering stress and disorientation that we induce in individuals by
subjecting them to too much change in too short a time.
Toffler (1928-2016), Future Shock (1970)
Alvin Toffler, the futurists’ futurist, has died in Los Angeles at age 87
In a trilogy of books – Future
Shock (1970), The Third Wave (1980),
and PowerShift (1990), Toffler described
the transition from the industrial age to the information age in these terms
“ The Second Wave Society is understood and based on
mass production, mass distribution, mass
consumption, mass entertainments, and weapons of mass destruction. You combine these things with
standardization, centralization, concentration, and synchronization, and you
wind up a style of organizations we all call bureaucracy.”
This is precisely what is occurring medicine and the health reform. The forces of managed care in the form of
HMOs, PPOs, and integrated large organizations and of government, as
exemplified by ObamaCare have sought to standardize, centralize, concentrate,
and synchronize health care into
organizational and governmental
bureaucracies. To a large extent, these
forces have succeeded.
Toffler predicted these changes:
The influence of personal computers
The coming of the Internet
The shift of mass manufacturing and marketing to
a computerized information society
Along the way,
Toffler coined these phrases “A
roaring current of change, “information overload,” “confusional breakdown,” “the
And he predicted displacement of workers who did not have
the time or inclination to learn the skills of the information age,
“The illiterate of the 21st century will not be
those who cannot read, but those who cannot unlearn, and relearn."
“Our technological powers will increase, but the side
effects and potential hazards will accelerate.”
“One of the definitions of sanity is the ability to tell
real from unreal. Soon we’ll need a new
Toffler was on target. The information age has accelerated change, we are overloaded with Internet information,
millions of workers have been displaced and
replaced by the computer, many of these
workers have been unable to unlearn the old way and to relearn the new
ways, the side effects and hazards are
becoming evident, and virtual reality has arrived
Changes are medicine include: consolidation and absorption of individual patients and physicians into large organizations; the transition from fee-for-service payment
based on clinical judgment to “value” payment based on data; the decline of private practice; the electronic revolution with its reliance
on data rather than clinical judgment;
and physicians’ rush to become hospital employment for economic security
or do cash only practices to escape 3rd party mandates and
Toffler foresaw “information
confusion” and “information overload.”
He did not foresee how these factors
will play out. Will an overreaching
global bureaucracy, i.e., the
establishment, call the shots? Or will those advocating national and individual
sovereignty and liberty, emerge as victors? The European Union, Brexit, Clinton, or Trump?
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