It occurs to me that training may be over-valued, and our failure to understand this is causing us a great deal of angst.

Today I am at the dealership from which I acquired my vehicle. It needs routine scheduled maintenance, as well as new brakes, front and rear.

Perhaps you’ve seen those commercials for AT&T wireless with the theme that “just OK” isn’t good enough. One has a mechanic saying his shop is “OK” at fixing brakes, adding, “If the brakes don’t stop it, something will.”

Perhaps we should get used to the idea that, when decisions about staffing are being made by people who see the value quotient differently from the way we’ve traditionally viewed it, the inevitable result is a proliferation of unqualified mid-levels.

This is a trend across many sectors of our economy. For example, the service manager at the Lexus dealership asked if it was okay for the guy who spent the morning clearing snow from the parking lot to do the work on my brakes instead of one of the Lexus-trained-and-certified technicians. I figure the dealership has to do things to increase profitability, and at least they’re being honest about it.

And when a healthcare enterprise uses Nurse Practitioners to do work that really should be done by physicians, it’s part of this broad trend to address the “value proposition” in the newly fashionable way.

Value is a ratio of quality to price. If you are just clueless about quality and have no idea that the Nurse Practitioner, or the guy who clears the snow from the parking lot, shouldn’t be treating patients who might have serious things wrong with them, then you don’t have any idea about the numerator in that ratio. So you just focus on the denominator, which means you try to enhance the “value proposition” by lowering price or cost as much as possible.

After all, why is “just OK”  (or even not really OK at all, but who is going to judge?) not good enough?

If the brakes don’t stop the vehicle, something will. All bleeding stops. The mortality rate is one per person.

The notion that morbidity can be mitigated, or that death can be forestalled, or that quality of life just might depend on the quality of health care … can we really afford such fancy ideas nowadays?

-Courtesy of Robert Solomon, MD