III. ATTAIN BY STRATAGEM


1. Sun Tzu would have said: In practice of healthcare, the best thing of all is to make full recovery with the whole body parts intact; to dissect and destroy the affected part is not so good. So, too, it is better to recover an organ entire than to remove it, to recover a tumour, a tissue or a cell entire than to destroy them.

2. Hence to perform and succeed in all your operations is not supreme excellence; supreme excellence consists in healing the disease's symptoms without operating.

3. Thus the highest form of medicine is to break the disease's pathogens; the next best is to prevent the junction of the disease's factors; the next in order is to treat the disease's symptoms in the outpatient setting; and the least favourable policy of all is to perform an treatment under a prolonged hospital admission.

4. The best practice is, not to admit into hospital if it can possibly be avoided. The preparation of operation theatres, convertible wards, and various implements of a hospital wing will take up three whole months; and the filling up vacancies over new positions for the wing will take three months more.

5. The physician, unable to figure out what to do, will request the whole body inspection with batteries of examinations, with the result that one-third of the tests are found irrelevant, while the cause of the symptoms still remains unknown. Such are the disastrous effects of an admission.

6. Therefore the skilful physician subdues the patient's anxiety without any prescription; he treats their symptoms without admitting them to the hospital; he overcomes their diseases without lengthy operations in the theatre.

7. With his teams intact he will dispute the mastery of healthcare, and thus, without dropping out a patient, his job will be complete. This is the method of attaining by stratagem.

8. The best practice is, if our available resources are ten to the target population's one, to propagate it; if five to one, to recommend it; if twice as required, to optimise its usage.

9. If equally matched, we can offer it as an option; if slightly scarce in resources, we can avoid utilising it; if quite unequal in every way, we can discourage it.

10 Hence, though an obstinate practice may be made by a small staff, in the end it must be exhausted by by the larger population.

11. 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.

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

13. (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.

14. (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.

15. (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.

16. 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.

17. Thus we may know that there are five essentials for healthcare excellence:
(1) He will win who knows when to treat and when not to treat.
(2) He will win who knows how to handle both superior and inferior symptoms.
(3) He will win whose health team is animated by the same spirit throughout all its ranks.
(4) He will win who, prepared care plans, waits to take actions before the conditions deteriorate.
(5) He will win who has healthcare capacity and is not interfered with by the politics.

18. Hence the saying: If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.

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

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