In The Thing (1929), G.K. Chesterton argued:
In the matter of reforming things, as distinct from deforming them, there is one plain and simple principle; a principle which will probably be called a paradox. There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, “I don’t see the use of this; let us clear it away.” To which the more intelligent type of reformer will do well to answer: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it.”
I will admit when I was a medical student and resident, I had a lot of opinions about how things should be different and should be done. Some of those were right and some where wrong. Some had the benefit of fresh eyes and some were the result of naivety and a narrow perspective. It’s often not possible to know which are which prospectively.
In The Lessons of History, Will Durant suggests:
Out of every hundred new ideas, ninety-nine or more will probably be inferior to the traditional responses which they propose to replace. No one man, however brilliant or well-informed, can come in one lifetime to such fullness of understanding as to safely judge and dismiss the customs or institutions of his society, for those are the wisdom of generations after centuries of experiment in the laboratory of history.
Cultural evolution is less often people changing their minds through enlightenment and more often just the replacement of old people and their old ideas with younger people and their new ideas. This isn’t always going to move in the right direction. Pendulum swings are hard to control. It’s also challenging, if not impossible, to understand which failed old attempts signify a bad idea that should be discarded versus reflect bad timing/context and should be retried.
I, too, roll my eyes when older people complain about young people. Generational politics are so incredibly tedious. But, sometimes, there is something there. Time marches on. I am not quite 40, but I can feel the aging. The gap between the youngs and the olds is impossible to ignore (or prevent). The trends discussed by Jonathan Haidt and others like in his excellent books The Anxious Generation and The Coddling of the American Mind are absolutely real.
There are so many problems in the house of medicine, but so many changes are just rearranging deck chairs and attempts to more fully embody the law of unintended consequences.
Healthcare is not insulated from broader cultural trends of quiet quitting, the desire for remote work, and the general American focus on individualism. But we’re always changing.
It’s not always possible to ensure we make things better and not just different, but more nimbleness and experimentation would help. More toe-dipping. We could be a little less precious with many of our core assumptions and be willing to try big changes instead of just marginal differences with big ripple effects (i.e. the same test, but not graded).
We need relentless iteration and experimentation, because it’s admittedly hard to know which parts of what we take to be the problem are Chesterton’s fence.