“Efficiency” has become the be-all and end-all of our culture. In a world defined by technique, efficiency is an unassailable defense against opposing viewpoints: one has only to say, “Well, this way increases efficiency,” to silence all the naysayers and get everybody’s heads nodding in agreement.
So my attention was riveted when I heard a physician wiser than I say, “All the efficiencies of the last fifteen years have reduced the time between patient and physician.” It was an offhand remark, mentioned in passing.
I thought, Wait a minute. Efficiency is a good thing. But less time with my patients or my doctor doesn’t sound like necessarily a good thing.
I went to my old Webster’s Collegiate Dictionary, Tenth Edition. “Efficiency” means “effective operation as measured by a comparison of production with cost (as in energy, time, and money).” “Efficient” means “productive of a desired effects.”
So “Efficiency” doesn’t equal “Good,” or even “Better.” In fact, “Efficiency” by itself says nothing about an activity’s moral content. Whether something is morally right or wrong depends not just on the means but on the desired effects, the ends we wish to achieve. If we are more concerned with increasing the efficiency of our projects than with the content or outcome of those projects, we are in danger of spending our time “committed to the quest for continually improved means to carelessly examined ends.”
“Efficiency” seems to have taken the driver’s seat in medicine. In my work as a physician I daily hear exhortations to increase efficiency, and new projects — no matter how onerous — justified by, “This will improve efficiency.” But is it possible that improving certain means (= increasing efficiency), without considering other means or the ends towards which those means tend, might actually be detrimental?
Returning to the physician’s statement above, we must ask, “What are the ends of medicine?” The answers are Legion, and depend largely upon whom one asks. To some, it may simply be “health.” To stakeholders and bean counters, it might revolve around profit and return on investment.
Several studies indicate that a good relationship with a trusted physician is very beneficial for health, particularly for those with chronic diseases. So a better relationship with a physician would be an efficient way to achieve the ends of health, and “Efficiency” might mean more time spent with patients building meaningful healing relationships.
But if one measures efficiency in medicine only in terms of “the amount the doctor bills for his services per hour,” then more time spent with individual patients actually decreases efficiency.
If we make out “Efficiency” to be an ultimate good, and if we define it as cost per unit of time, then we will have destroyed medicine and remade it into something barely recognizable as the vision of Hippocrates (and Jesus). I maintain that this process has already advanced far, that we are steadily improving the means to poorly examined ends, and that we must reexamine the ends of medicine before we consider redesigning the means.