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If there were a line in the sand to demarcate the philosophical collapse of American medicine, it would be the inability to adapt to technological postmodernism.  Modernism has been a wheezy old intellectual system based in the late 1800’s which managed to sustain its momentum up until the Great Depression.  Many of the concepts and beliefs of Modernism have fallen by the wayside nearly a hundred years ago.  But still, Industrial Modernism is the high water mark to which our American Republic achieved; and went no further.  Now, it is a gentle collapse into the twilight, I fear.

Postmodernist individualism was a principle that “one size fits one” – the skill of crafting technology to the service of human existence and individuality.  Some of it whispers into the present through computer technology and the individualization of the iPhone and apps.  However, the great mass of our worldview is stuck in the mass-production model.

We consider the mass-production of medicine, and the use of Procrustean techniques to make it look like personal care.  It is failing broadly.  There is no human core.

Properly considered, the construction of a medical Postmodernism would be to render the greater things invisible, so that the aspects of individual care might shine through.  To some degree, it is coming faster in clothing than in medicine.  Bespoke, hand-made one-of-a-kind clothing has always been there, and always expensive.  Tailors are not cheap.  But now, we are seeing the rise of CAD-CAM tailoring, which makes it far cheaper to construct fitted products for an individual than the old, handmade clothing.  Bespoke clothing will be here soon enough; your measurements make your clothes.

Medicine?  It’s the other way around.  We see Mass Data – the EMR/EHR which has grown into immobility.  There is no attempt to get the right facts and the right information to the clinic in a transparent fashion.  We could easily, so well, clear away the details of billing and scheduling into transparency; but we have no interested in individualizing or humanizing the experience.  We seem to believe that Soviet Medicine, alone amongst the USSR enterprises, was simply not tried long enough.

In Gettysburg, the ridge demarcated the High Water Mark of the Confederacy.  It ebbed, first gently, and then in a tumult, until it collapsed.  So, perhaps, our Republic; certainly, indeed, or medical care.

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