The general practice is the bulwark of the community health

Now the general is the bulwark of the State; if the bulwark is complete at all points; the State will be strong; if the bulwark is defective, the State will be weak.

There are three ways in which a ruler can bring misfortune upon his army:--

(1) By commanding the army to advance or to retreat, being ignorant of the fact that it cannot obey. This is called hobbling the army.

(2) By attempting to govern an army in the same way as he administers a kingdom, being ignorant of the conditions which obtain in an army. This causes restlessness in the soldier's minds.

(3) By employing the officers of his army without discrimination, through ignorance of the military principle of adaptation to circumstances. This shakes the confidence of the soldiers.

But when the army is restless and distrustful, trouble is sure to come from the other feudal princes. This is simply bringing anarchy into the army, and flinging victory away.

From "Sun Tzu on the Art of War - The Oldest Military Treatise in the World"

Translated from the Chinese By Lionel Giles, M.A. (1910)

Discussion:

To apply this part of the text of Sun Tzu into the current health context where the focus is shifting toward community care and shared decision making, it would be justifiable to substitute "the community health" for "the State" as the objective of protection. This translation enables us to discuss implications of dubious health choices and pro-market health reforms.

Translation:

Now the general practice is the bulwark of the community health; if the bulwark is complete at all points; the community health will be strong; if the bulwark is defective, the community health will be weak.

There are three ways in which a community can bring misfortune upon its health team:--

(1) By commanding the health team to advance or to retreat, being ignorant of the fact that it cannot obey. This is called hobbling the health team.

(2) By attempting to govern a health team in the same way as it administers a commercial business, being ignorant of the conditions which obtain in a health team. This causes restlessness in the clinician's minds.

(3) By employing the officers of its health team without discrimination, through ignorance of the medical principle of adaptation to circumstances. This shakes the confidence of the clinicians.

But when the health team is restless and distrustful, trouble is sure to come from quality and safety issues. This is simply bringing apathy into the health team, and flinging clinicians away.

Ray Murakami