Please excuse this long letter, I did not have the time to write a shorter one. Johann Wolfgang von Goethe
Brevity and minimalism go a long way. This post deals with the “less is more” principle in medicine and how a zen-like attitude can make you a better physician.
Have you ever heard of a thing called “minimal viable product” or MVP? No? Well, it’s a term coined by the lean startup movement and describes the minimum amount of features a product has to have for it to solve the the customer’s needs. Think Writer App versus MS Word or Basecamp versus MS Project. Writer and Basecamp have way fewer features than their MS counterparts but they do what they purport to do in a much more efficient and elegant way. The lean startup movement claims that you should always start with an MVP and only add features in case of market and customer need.
“What does that have to do with medicine?” you ask. A whole lot we think. Many of us will find the following situation familiar: a decompensated 50-something heart-failure patient is accepted to the ward. He has several comorbidities and as you write down his drug regimen on the chart, you run out of lines to write on because he takes over 20 drugs on a regular basis. You stabilized him and you embark on the mission to optimize his chronic drug regimen. You feel that two important drugs are missing from his long list. However, your experience and the literature tell you that compliance goes way down if the patient gets over 10 drugs. So you have to ditch most of his other drugs before you can add new ones. In other words, you have to find the minimal viable therapy (MVT) that solves the patient’s problems. Knowing the two drugs that are missing is the easy part – even the unexperienced could figure that out; but identifying the non-essential is where your skills, experience and art are needed.
“Less is more” is a general principle that holds true in many realms of life: design, technology and even medicine. Take choices for example: many of us like restaurants with fewer dishes on their menus better than their long-listed counterparts. The number of options actually decreases our satisfaction with our final choice (for more info, watch this great TED talk by Barry Schwartz). Or teaching content: articles and books usually get better as you shorten them. Similarly, we all sat through presentations that would have been great had the presenter only used eight slides. Instead he used 47 and the presentation was close to unbearable. The same idea is expressed in Goethe’s quote above.
ZenMed’s summary: learn to identify the unessential, don’t try to be everything to everyone and don’t expect your therapies and interventions to be that either. Go one step back then two steps forward – just like Kwai Chang Caine in the infamous series “Kung Fu”; be efficient and never forget that less is usually more. Your Master will be proud of you 😉