Tuesday 7 January 2014

The skilful clinician puts himself into a position which makes harm impossible

To see victory only when it is within the ken of the common herd is not the acme of excellence.

Neither is it the acme of excellence if you fight and conquer and the whole Empire says, "Well done!"

To lift an autumn hair is no sign of great strength; to see the sun and moon is no sign of sharp sight; to hear the noise of thunder is no sign of a quick ear.

What the ancients called a clever fighter is one who not only wins, but excels in winning with ease.

Hence his victories bring him neither reputation for wisdom nor credit for courage.

He wins his battles by making no mistakes. Making no mistakes is what establishes the certainty of victory, for it means conquering an enemy that is already defeated.

Hence the skillful fighter puts himself into a position which makes defeat impossible, and does not miss the moment for defeating the enemy.

Thus it is that in war the victorious strategist only seeks battle after the victory has been won, whereas he who is destined to defeat first fights and afterwards looks for victory.


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:

The Hippocratic Oath and the principle of evidenced-based medicine would help to interpret this part. The patient privacy means that the clinician's excellence may not be widely known to the public. The phrase "only seeks battle after the victory has been won" quite matches the principle of evidenced-based medicine.

Translation:

To see recovery only when it is within the ken of the common herd is not the acme of excellence.

Neither is it the acme of excellence if you treat and cure and the whole community says, "Well done!"

To lift an autumn hair is no sign of great strength; to see the sun and moon is no sign of sharp sight; to hear the noise of thunder is no sign of a quick ear.

What the ancients called a clever clinician is one who not only cures, but excels in curing with the privacy of the sick protected.

Hence his practice bring him neither reputation for wisdom nor credit for courage.

He cures his patients by making no harm. Making no harm is what establishes the certainty of safety, for it means treating a condition that is already supported by evidence.

Hence the skilful clinician puts himself into a position which makes harm impossible, and does not miss the indication for treating the condition.

Thus it is that in healthcare the competent clinical director only seeks decision after the evidence has been examined, whereas he who is destined to fail first decides and afterwards looks for evidence.

Ray Murakami

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