Tuesday, 21 May 2013

Vision in reality

I have recently being trying to write a book. I harboured romantic ideas of sitting down at my desk, and tapping out my ideas, sending it to a publisher and then watching the money roll in.

I did sit down, and I did tap out a first draft, and then realised that that is when the really hard work begins. The draft I currently have is already very different from the book I intended to write, and having reread it, I realise that it will have to change again if it is to be palatable for popular consumption. I say popular guardedly: a second realisation is that the work I have produced can at best be described as niche, but is probably more accurately described as obscure.

As is my way, this experience triggered some thinking.

Writing a book is something over which the writer should have total control: the words chosen to fill the blank page are wholly the choice of the writer. And yet writing can sometimes create the sense that you are being dragged along by another force - sometimes it feels as if other forces are acting through you. This is no doubt a feature of the writer's limitations: it feels foreign, because the words that result do not quite capture the true essence of what you are trying to say.

Great writers show total mastery: reading the work of a true word smith evokes awe. Sometimes it can be annoying: Martin Amis knows how to construct a beautiful sentence, and he knows it; he spends entire books wowing us with his linguistic flourishes, to the extent that he starts to come across as pompous and haughty. No one likes a show-off.

Writing words that are only ever an approximation of the true essence of what you are trying to say could be a motif for life: our actions and outcomes are only ever an approximation of what we are actually aiming for.

I have been thinking a lot recently about how the way that I practise medicine is only ever an approximation of the way that I think it should be practised. There are fundamental aspects to the way that we deliver care that I would change, if I had total control over the way the system is organised.

But perhaps, even if I had total control, the system that would result would be different from the perfect one I imagined, because translating vision into reality is difficult, and because my vision of perfection may not actually be the system that best serves patients.

And this is my message for the day: it is important to have clear visions of what perfection looks like, but it is also important to consider how, in the real world, we can begin to deliver that vision of perfection. In our own imaginations we are not hamstrung by the mechanics of every day life, and rules and limitations are easy to ignore. This can make solutions seem simpler than they actually are.