Could the Memoirs of a French Marquise Provide Perspective on Today’s Healthcare Tumult?

Sept. 25, 2020

The book jacket to Dancing to the Precipice: The Life of Lucie de la Tour du Pin, Eyewitness to an Era, by Caroline Moorehead, explains it perfectly. “Her canvases were the court of Louis XVI and Marie Antoinette; the Great Terror; America at the time of Washington and Jefferson; Paris under the Directoire and then under Napoleon; Regency London; the battle of Waterloo; and, for the last years of her life, the Italian ducal courts. Like Saint-Simon at Versailles, [or] Samuel Pepys during the Great Fire of London, Lucie Dillon—a daughter of French and British nobility… was the chronicler of her age.”

I am currently rereading this very compelling 2009 biography, Dancing to the Precipice, by British author and historian Caroline Moorehead, of the life of Lucie Dillon, the Marquise de la Tour du Pin—a woman who at the age of 17 and newly married to a nobleman, was presented at the court of Louis XVI and Marie Antoinette at Versailles, in 1787—just two years before the fall of the Bastille and the shattering events of the French Revolution. The Marquise was no ordinary noblewoman—she wrote a memoir of her life several decades later that chronicled the astonishing developments of her time, and which ended up proving invaluable to historians. And that, of course, is the fascination in books like Precipice, in which an astute observer’s witnessing to the events of her time can give us insights far beyond what academic discourses can.

And of course, living through such times can of course be terrifying and disconcerting. Take for example, the period of the Great Fear in the late summer of 1789, as the revolution began to pick up pace. “In the countryside, a sense of panic was catching fire. Towards the end of July, these grievances burst out into what became known as the Great Fear. All over France, the politics of paranoia were feeding into the settling of old scores. Châteaux were set on fire and their contents looted; the symbols of the ancien régime had become targets, and none more so than the nobility and their possessions. It was rumored that a 94-year-old marchioness was thrown onto a smoking stack and died watching her servants distributing her linen, furniture and porcelain. One countess was said to have been strangled; another to have had her teeth broken.” Of course, far worse would happen, and the Marquise documented the dramatic shifts taking place in her time. What’s self-evident is how difficult it is for any individual living in a time of tumult to imagine what the resulting new world will be like. The Marquise herself, born in 1770, lived until 1853, dying in Pisa at the age of 83, and having seen several regimes rule her country.

No guillotines are involved these days, of course, but those living through the current upheaval in U.S. healthcare certainly are getting a glimpse of a new world beyond the parameters of the current moment. The COVID-19 pandemic has added yet another element of instability to the current healthcare landscape, forcing the leaders of patient care organizations to adjust their understanding of the present and the near future, as a combination of demographic changes in society, the ongoing cost explosion in U.S. healthcare, and surging consumerism, are forcing the rethinking of many old assumptions.

Are you ready for the accelerating evolution of U.S. healthcare? In this issue, we offer a cover story package of case studies around patient engagement and the patient experience, as well as a feature on the new world of payer-provider collaboration around population health. There is much here to savor—both revolutionary and evolutionary. Enjoy!