How To Heal Our Broken Health Care System
My dear friend and mentor Dr. Rachel Naomi Remen and I have been talking a lot lately about how to heal our broken health care system. The New York Times just wrote an article Medicine’s Search For Meaning about The Healer’s Art program that Rachel created, which is taught in half of all medical schools in the US and in other countries across the globe. I was lucky enough to be part of a pilot program years ago that allowed me, as a practicing physician, to participate in The Healer’s Art program at UCSF, right alongside the medical students. It was life-changing for me, as it has been for countless medical students.
This New York Times article spawned such a flurry of comments, largely from doctors, that the New York Times published a follow up article Who Will Heal The Doctors? Last I checked, there were over 800 comments between the two articles and Rachel is reading every single one of those comments.
The conversation happening in the comments section is even more fascinating than the articles. The reporter ends the article with this:
"Could physicians come together to overthrow the current order — to start a movement to, say, Occupy Medicine? If they did, what would be the unifying cry? Down with health insurers? Tort reform or bust? Or would it begin by expressing the thing that is most precious to them that has been lost: the opportunity to practice medicine in a way that is worthy of their dedication and love. Reclaiming a sense of meaning in medicine could be the first step to rescuing the profession."
Rachel and I have been watching this unfolding conversation with more than a little awe. We're planning to lead a teleclass together in January, so we’ve been noodling all of this and brainstorming what we, as a profession, can do to reclaim medicine.
Here are some of my thoughts in the wake of these conversations.
The Lineage of Medicine
The current medical system requires most doctors to sell their souls to some degree. Doctors were called to the lineage of healing that is as old as our species, much as priests are called to the priesthood. They endure a decade's worth of traumatic medical education that leaves them with PTSD.
Then they enter a system that asks them to violate their ethics. It goes against our very ethics to be expected to see 40 patients per day. It goes against our ethics to have to spend so much time filling out paperwork or entering data into a computer that we don't have any time left to listen to the patient. It goes against our ethics to betray the sacredness of the doctor-patient relationship.
When I was still seeing patients in the system, I often went home and cried because I knew how much more I could have offered to my patients if only I'd had more time with them, time to sit at the bedside and hold a hand, time to be present with their pain, time to really appreciate the honor it is to have a front row seat on life and death.
How We Learn Helplessness
I knew I wanted to practice medicine differently, but I felt helpless and hopeless and victimized by a system that had corrupted my ability to practice in alignment with my ethics. The feeling that I was selling my soul in the way I was practicing medicine got so strong that I had to finally leave medicine. I couldn't keep my integrity and practice medicine that way anymore, but leaving medicine didn't feel right either because the calling to the lineage hadn't gone away. It felt wrong to quit, but it felt even more wrong to keep selling out my soul.
I'm not alone in feeling this way. Some of the best doctors are quitting, because like me, they can't bear to have their ethics violated anymore. But we don't want the best doctors to leave medicine! We need to find a way for doctors to, once again, practice in alignment with their ethics. I know many doctors feel this way. They are allowing the system to violate their ethics, and the pain of the betrayal is almost impossible to bear. Yet why are doctors just rolling over and letting this happen? (Read my thoughts on letting go of victimhood here.)
Take Back Medicine
Some are breaking out of the managed care insurance vice by starting concierge or cash-based medical practices so they can have more time with patients. But this is just a Band-aid solution, and it doesn't acknowledge that excellent health care is a human right, not a privilege only reserved for the wealthy. It works for the doctor, because the doctor can then practice in alignment with her ethics. But it doesn't work for patients who can't afford to go outside the insurance system.
Doctors and patients need to solve this problem, not politicians. We are a smart, compassionate, ambitious, loving, creative bunch. What a mighty good army we could be, in service to a worthy cause. Why are we not mobilizing to reclaim the lineage that belongs to us? Why are we throwing up our hands and acting like we're victims of a corrupt system instead of pushing those who threaten to corrupt us out of the middle of the doctor-patient relationship?
We act like we're waiting for someone to come save us, but no one in Washington is going to throw us a lifeline. There's too much money, too much greed, at stake. Doctors, we must reclaim the lineage and save ourselves.
Occupy medicine, anyone?
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