John Henry and his hammer


If you are a fan of American folklore, then you must know the story of the mighty John Henry and his hammer. Whether legend or factual history, the story of John Henry and his attempt to outrun technology is just as applicable today as it was in the 19th century.

In an age of automation and analytics, we sometimes lose focus on honing the artwork in on our God-given talents. Perhaps we should learn from John Henry’s lesson and not try to outrun technology, rather it can certainly be given a place in the back seat.

John Henry was a former slave that was hired to work on the railroads in the 1800’s. He was known as a “steel-driving man”, because he could drive a railroad spike into the track with one swing. He was revered as superhuman by his peers, and viewed himself as a master of his art.

So, the story goes, the railroad company decides to invest in this new-fangled steam-powered driver machine that will outwork a man and save money. The age of the machine had come, and there was no room for debate, except, of course, from John Henry.

Taken aback and not to be outdone, Big John told the foreman to set up a competition between he and the mechanical driver to determine who was better, man or machine.

Early the next morning, John Henry arrived with a hammer in each hand, prepared to take on the steam driver. As a huge crowd gathered, John and the machine took to driving spikes on each side of the track. As they both worked well into the heat of the day, John stayed one spike ahead of the machine, never relenting in intensity.

By the end of the day, John Henry had indeed beaten the machine, but fell dead right there on the track from exhaustion. Like all humans, John was willing to fight to his dying breath to defend his art.

Whether true or not, the tale of John Henry is one that summarizes the somewhat hostile relationship between man and machine. Though we all rely on them in this day and age, none want to admit our dependence on machines. Like cake, too much use of these machines inevitably leads to harmful side effects.

I can certainly speak to this phenomenon in the healthcare world, where data-driven health measurements, called outcomes, now play a huge role in performance analytics and insurance reimbursements. Plainly stated, if the patient of a healthcare provider doesn’t hit certain goals in their health measurements (i.e. cholesterol, blood sugar, blood pressure, etc.), then the provider will receive less money in return for their services from the patient’s health insurance company than if they were hitting all these outcome targets.

In even plainer words, doctors, pharmacists, nurse practitioners, and so on will be judged by their numbers, and not the art of their care.

I think I hear big John Henry shouting for his hammers!

Please don’t misunderstand, I love the fact that technology allows us to give higher quality care to our patients. If data-driven analytics help me prevent someone from having a heart attack or stroke, then I am all in! What has happened here, though, is the same scenario that the steam driver birthed.

The quality of our care is graded on data-points purely, and does not take into account the art that we call health care. Telemedicine and electronic health records are great, but they do not come close to one-on-one interactions with our patients.

A prime example of these pitfalls comes from an interaction I had recently with a patient.

This individual met all the data-driven requirements of therapeutic initiation on a cholesterol-lowering medication. She is diabetic with elevated cholesterol levels, and, based on the guidelines, should be placed on medicine for high cholesterol.

Upon conversation with the patient, I discovered that she had given one of her kidneys to her ill daughter years ago, and the thought of adding medication to an already over-worked kidney scared her. Furthermore, her cholesterol levels were only slightly elevated, and she has worked to control her diabetes and cholesterol for years with diet and exercise. So, we agreed that this medication was not for her.

Will the data gods accept this as reasonable? Nope. Would they be able to make the right therapeutic choice for this patient by just looking at the numbers? Not likely. Their machine would see the spike and automatically drive it with a predetermined conclusion.

Luckily, at a free clinic, insurance reimbursements and outcome measures do not take away from our care. Our providers continue to quest for high quality care, but do not have to hang our hats on the guidelines alone.

So, what about the rest of the medical world? Should we demand to stick to the guidelines and data-driven analytics without regard to individual patient care? Should we buck the system and set up shop off the grid somewhere? Who knows? We could all get angry about the situation as it is, but we only have ourselves to blame for this. After all, we were the ones that made the machine.

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Justin Coby has been affiliated with Health Partners Free Clinic as a volunteer pharmacist since 2007, and was appointed executive director in 2012.

Justin Coby has been affiliated with Health Partners Free Clinic as a volunteer pharmacist since 2007, and was appointed executive director in 2012.

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