In 1949, a Montana forest fire engulfed a parachute brigade of firefighters. Panicking, they tried running up a seventy-six-percent grade and over a crest to safety. Their commander, a man named Dodge, saw that it wasn’t going to work. He stopped, took out some matches, and set the tall dry grass ahead of him on fire. After the new blaze spread up the slope, he stepped into the middle of the burned-out area it left behind, lay down, and called out to his crew to join him. He had invented what came to be called an “escape fire.” His men either thought he was crazy or never heard his calls, and ran past him. All but two were caught by the inferno and perished while Dodge waited inside his escape fire, virtually unharmed.
Doctors are often dropped into the middle of a patient’s disease cycle, applying what they know to a situation that may not be completely knowable. These physicians face a difficult conundrum: which care is appropriate? And when care is provided, how can they know that the care was good care? Many would suggest that doctors use the standard of care. Therein lies the heart of the conundrum – unlike Dodge’s ingenious single path to safety; the current medical standard of care is widely variable. Unsurprisingly, two different patients, exhibiting similar disease symptoms in the United States can expect to receive very different care.