The accelerating pace of change

Géronte: It seems to me you are locating them wrongly: the heart is on the left and the liver is on the right. Sganarelle: Yes, in the old days that was so, but we have changed all that, and we now practise medicine by a completely new method. Act II, scene 4, Le Médecin Malgré Lui by Molière

Once upon a time (it’s all changed now) everyone knew a song called The Vicar of Bray.¹ The words—suitable, somehow, in their buccolic, 17th century way, for Christmas—highlight the absurdity of our belief that our era is uniquely prone to change.

As King James succeeded King Charles, followed by King William, Queen Anne, and finally King George, the Vicar of Bray swung back and forth, left and right, Protestant and Catholic, Whig and Tory, to cling to his living. Like Euripides’ Trojan women being carried across the Aegean to slavery, the ceaseless incursions of rapacious Vikings into Medieval Britain, and the recent obliteration of great tracts of Bangladesh and Nicaragua by storms, the six verses of The Vicar of Bray provide a chronicle of what to us in our tolerant, disease-immunised, risk-insured, pension-squirrelled, and air-bag-protected world would be unthinkable disruption.

The enigma

Why is every generation so impressed by its own change? In answering it is helpful to think of a gramophone record playing. You may imagine it playing The Vicar of Bray if you like continuity. The little needle is bucketing down the Cresta run of its track, wobbling from side to side, apparently in chaos. But behind the wobble we know that it is guided by a deeper purpose. Despite an occasional “crack” or “pop” as the needle hits a particle of dust, from all this busy, busy movement we find emerging, miraculously, a rustic tune.

The thing we see so much of in our lives today is wobble. And we see it not only because there is a lot of it about but because we can see so much further than we could in the past. Far beyond the literal horizon, thanks (or no thanks) to technology, our gaze now encompasses the whole world. And, what is more, the artificial media we see through are interested almost exclusively in change. They have to be.² Exactly as a preying bird is selectively sensitive to movement, so a satellite surveying an ocean of calm will report back only when it sees a ripple.

A lot of this is great fun. When we are told that clinical governance, the latest wobble, has “arrived,” is the talk of eager meetings, must be embraced by friends of change, we are keen to know what it is.

Of what mighty tune, we ask, does it form a humble part? We know, with Robert Frost, that, “Most of the change we think we see in life is due to truths being in and out of favour.” So what, we ask each other, was clinical governance called last time? For which ancient truth is it the latest name? Or is it really a truth at all? Surely, we say, it can’t be the random “pop” of a particle of dust in what Tennyson described as “the ringing grooves of change.”

A different instrument

Notice how much better an example the old vinyl record makes than the new CD. You can’t picture the music flowing from a string of coded pits as easily as you can from a wobbling needle. The stream of binary position fixes, several thousand every second, defining precisely each and every wave in the sound we hear, is almost entirely beyond our comprehension. And this is a performance which wouldn’t be disturbed by a speck of dust. But again, it doesn’t really matter: “It’s just the same old tune,” as a patient once told me of her fertile extra-marital adventure, “played on a different instrument.”

But how we like our new CD. Tomorrow, perhaps, we will like our DVD (digital video disk). We want the slimness of our lap-top envied. We want to flash our coloured mobile phone. We will write “Serving the public of Lambeth” on the wall of our hospital (in case it might be doing something else). We prioritise. We privatise. We shake things up. We dumb things down. These are the instruments with which our new world proudly plays.

Yet behind it all the great theme carries on. A great symphony. Unfinished, as it will always be.

The timeless theme

We hear it when we close the surgery door and turn to the patient. When we put down the pen, look away from the computer screen and turn off (sorry, children, I insist) the video camera. And give our undivided attention and our sympathy. Then we are part of the great tradition which is unchanged since the dawn of civilisation.

“Forward, forward let us range, Let the great world spin for ever down the ringing grooves of change.”³

But “The more things change, the more they are the same.”⁴

And “...whatsoever King shall reign,

I will be the Vicar of Bray, sir!”¹

Figure.

Much of the movement in our lives is wobble