“It is what it is”

The central protagonist of “Click, Double-Click” is a doctor who rails against the bureaucracy.

I ran into an emergency physician of my acquaintance last week and asked him what he thought of “the four hour rule”.  In the language of medical “audit”, the four hour rule is a “criterion”.  The press often define the four hour rule in a rather slipshod way: all the patients have to be “seen” within four hours.  This is not accurate.  The criterion is that all patients should be discharged from the emergency department within four hours, irrespective of their “disposition”.  “Disposition” is a euphemistic softening of the word “disposal”.  We don’t “dispose” of patients; at least, not yet.

Medical managers remain infatuated with “targets”.  In the language of medical audit, a target is a “standard”.  Hence the standard might be that 95% of patients must be discharged within four hours.  The standard often looks as if it has been plucked out of the air.  After all, if it’s a good idea, why not make it 100%?  The achievement of the standard would be regarded as a “surrogate marker” for “quality”.  It seems clear to me that it is quite the opposite; the easiest way to meet the four hour rule is to drop all ambition for quality.  I told my ex-colleague that I thought the four hour rule, to borrow an expression that has found favour with some of our politicians, “a steaming pile of nonsense.”  Quality with a capital K.  Did he agree?

Well, I thought he might say yes, or no, or even the nuanced “yes and no”.  In fact, he shrugged, and said, “It is what it is.”

I have been worrying about the expression “It is what it is” all week.  What can it possibly mean?  In one sense it clearly means nothing.  It’s an expression of indifference, a verbalised shrug.  There’s no point in whingeing about the four hour rule because it can’t be changed.   It’s like the weather, or one’s mortality, or the second law of thermodynamics.

“It is what it is” need not be tense-specific.  In referring to the past, “What has happened, has happened.  The important thing is we draw a line…”  In the future, “What’s for you will not pass you by.  Que sera…”

“It is what it is” is in fact a surrogate marker for the condition of being downtrodden.  Whenever you say it, you are admitting defeat to the bureaucracy.  You are turning yourself into an automaton.  You become a functionary who occupies a station along the conveyor belt of a sausage factory.  Don’t do it.  Never shrug.  If you find yourself saying, “It is what it is”, make damn sure you really are talking about the second law of thermodynamics.

One thing I’ve noticed about hare-brained schemes such as the four hour rule, is that sooner or later, even the people who dream them up eventually realise they are worthless.  Then something curious happens.  History is rewritten.  “The four hour rule was right for its time, but has outlived its purpose.  We need to change, going forward.  What has happened, has happened…”  This is prelude to the introduction of the next steaming pile of nonsense.  You might say, “It isn’t what it is…”