Posted by: Witch Doctor | August 27, 2011

Stay hungry. Stay foolish.


“Your time is limited, so don’t waste it living someone else’s life.

Steve Jobs, 2005

In 2005 Steve Jobs made a speech to the students of Stanford University. If any life seems to illustrate The Butterfly Effect, his does. He tells three stories about his life.

His first story is about connecting the dots.

“Again, you can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.”

His speech made The Witch Doctor think about so many things that this post is liable to ramble on for ever, so she’ll just mention a couple of these thoughts relating to medicine.


His second story is about love and loss.

“I was lucky — I found what I loved to do early in life. Woz and I started Apple in my parents garage when I was 20. We worked hard, and in 10 years Apple had grown from just the two of us in a garage into a $2 billion company with over 4000 employees. We had just released our finest creation — the Macintosh — a year earlier, and I had just turned 30. And then I got fired. How can you get fired from a company you started? Well, as Apple grew we hired someone who I thought was very talented to run the company with me, and for the first year or so things went well. But then our visions of the future began to diverge and eventually we had a falling out. When we did, our Board of Directors sided with him. So at 30 I was out. And very publicly out. What had been the focus of my entire adult life was gone, and it was devastating.”

“I didn’t see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.”

Reading this made The Witch Doctor wonder how many doctors, though superficially successful, feel “heavy” and how much of that heaviness they now carry is due to the gradual eroding of their professionalism, and to the wedge being driven between them and their patients caused by the politics of “change,” “pathways,” “ referral vetting,” “revalidation,” “dumbing down” and much more.

Will there come a time when the question is asked:

“Where have all the doctors gone?”

Will they go to another place where they feel “light” again, so they can do something else, learn something different that they love, and not waste their short time in this world living someone else’s life? The kind of heavy, unwanted life that politician’s from all parties have imposed upon them in recent years, with much more of the same to come?

His third story is about death.

“About a year ago I was diagnosed with cancer. I had a scan at 7:30 in the morning, and it clearly showed a tumor on my pancreas. I didn’t even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctor’s code for prepare to die. It means to try to tell your kids everything you thought you’d have the next 10 years to tell them in just a few months. It means to make sure everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes.
I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery.”

I suspect doctors in the UK wouldn’t have cried out loud. Maybe they do in America. Whether what was actually said was more subtle than portrayed in the presentation or not, we will never know. But why oh why, would a doctor giving the likely diagnosis and prognosis of pancreatic cancer not wait until the histology results were present? OK, the patient might ask very specific questions but there is a way of dealing with this when the answer is unknown.

It is called The Art of Medicine.

As a medical student, The Witch Doctor was always taught never to diagnose cancer, far less give a prognosis without histology. “Never” is of course too strong a word since some tumours are in situations that might be too risky to biopsy or there may be other reasons for not doing so. But, according to his account, Steve Jobs’ tumour was going to be biopsied that evening, so why in the name of all that’s wonderful advise him to “put his house in order” before the results were available?

So why am I focussing on this?

Well, it is very seldom that The Witch Doctor mentions patients, however, I can say some things in broad terms. She knows someone who has recently experienced the trauma of being told that he had a tumour that would kill him very quickly. No histology – although the reason for this was a valid one. This man was pretty devastated by this news that came out of the blue and set about “putting his house in order” as best he could, given the difficult symptoms he had at the time. The family were also told of the diagnosis and they too were devastated. There are several nuances to this story, but to cut it short, thankfully the diagnosis was wrong and everyone is very relieved. However, the problem was that one of the consultants concerned was not an artist. He dominated those who were, and did his own damned thing! He practised the Science of Medicine very well. He treated the Art of Medicine with disdain. He was also a great ticker of boxes and a watchful waiting approach is often at odds with the box–ticking mentality. He wanted to deal with the certainty of a diagnosis rather than the uncertainty of a differential diagnosis. And so the patient went through a roller coaster ride of what can only be described as un-necessary torture lasting several weeks. He is expected to make a full recovery and is already showing signs that this will be the case.

Is dumbed down, protocol driven medicine compatible with the art of medicine?

And if the art of medicine is replaced by protocols, skills, guidelines that are really instructions, payment by results, etc how many doctors will feel the call to shed the burden and feel light again?

If you read the full text of Steve Jobs’ speech you will find out why it might be better to stay hungry and foolish.

redapple.jpg a red apple ……………………

The Witch Doctor – Link to a random page





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