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. Rachel and I are 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 had 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).
I know you thought you were helping me when you taught me that the needs of my patients were more important than my own self care. I know you thought you were training me to be an exceptional doctor when you forced me to scrub into surgery when I had the flu, wearing a diaper and an IV so I wouldn’t throw up, pass out, or have to scrub out because of my diarrhea. I know you allowed me to be the victim of years of sexual harassment at the hands of my physician professors, not because you’re evil, but because you’re just asleep, and you mistakenly think “boys will be boys.”
I know you didn’t mean to make me sick. And when I was taking 7 pills by the time I was 33 just so I could keep selling out my body in order to practice medicine, you didn’t realize you were hexing me when you labeled me “chronically ill,” suggesting that I would die in my fifties from a heart attack.
I know that when you expected me to work 72 hour call shifts, you thought it was because someone had to deliver those babies. And when you insisted I see 40 patients a day, limiting me to 7 ½ minutes with my patients, you thought you had no choice because of how managed care insurance executives have bastardized you.
I know you’re blind to how you’re being manipulated by Big Pharma, and you think you’re doing us favors by hosting “drug dinners” funded by Merck and Pfizer. I know you feel manipulated by patients who come in asking for prescription drugs by name because they’ve been duped into asking by ads aimed directly at patients, funded by Big Pharma (a practice which is only legal in two countries in the whole world- the US and New Zealand.)
I know you’re scared of getting sued because of vicious ambulance-chasing medical malpractice attorneys who have left you feeling like you have to be perfect, when medicine is an imperfect science. I know you order too many tests to try to protect yourself from those lawyers, and your greatest fear is that someone will die on your watch, and someone will blame you. But death is an inevitability for all patients, when their times come, and I hate to break it to you, medicine. But you’re not in control of when people die. God is.
Is medicine saving us- or killing us? Are doctors helping you- or harming you? Are you improving your health by taking prescription drugs- or are you decreasing your life expectancy? Are you getting the medicine you really need? Do you even know what kind of medicine that is?
These are the questions I answer in my third TEDx talk, which I delivered live at TEDxFargo, which was organized by Fargo community leader and Whole Health Medicine Institute physician Dr. Susan Mathison.
I had a meltdown on the plane on my way to Fargo because I knew what I would be discussing has the potential to be wildly controversial, and I wanted to ensure that my message was not misinterpreted by the very people I seek to serve- doctors and patients. I reached out to one of my mentors, Brené Brown, and she talked me off the ledge with an email that guided me with exactly the advice I needed. I wound up rewriting my speech on the plane only one day before I gave the talk.
I once wrote a whole book that is yet unpublished called BROKEN: One Doctor’s Search For The Lost Heart Of Medicine. It’s still unpublished, but I now know the real reason - because my role is not just to raise awareness of how broken our system is, but to be a force for healing it.
I’ve known this for many years - 7 ½ to be exact - but I’ve been so overwhelmed by the enormity of such a mission and so traumatized by the system itself that I’ve resisted this calling. Until just recently, when I’ve finally made peace with my calling and agreed to lend myself and my online platform to the service of healing my beloved profession. My upcoming book Mind Over Medicine: Scientific Proof You Can Heal Yourself, as well as the TEDx talk I gave in December 2011 and the one I'm giving in November 2012, the lectures I’ve been giving around the country this year, and many of my blog posts are devoted to being a spokesperson for this vision.
The vision began as fuzzy idea, difficult to articulate and impossible to imagine coming into being. I knew it had everything to do with love and hope and healing touch, but I wasn’t sure about the cursed “how’s.” But over time, my vision has crystallized, the tribe of people who share my vision is gathering momentum, and I already see it coming true, at least in my mind’s eye and small pockets of the world, if not ubiquitous in present reality.
They say if you can’t dream it, you can’t do it. So this has been the first step - getting clear on the dream.
In my upcoming book Mind Over Medicine: Scientific Proof You Can Heal Yourself (Hay House, 2013) and in many recent blog posts such as this, this, and this, I talk a lot about the mind’s power to heal the body. But when you or a loved one is sick, how do you know when to employ the mind’s self-healing powers versus when to get thee to an emergency room lickety split?
Knowing how to integrate the mind’s healing powers into the world of conventional medicine can be tricky, so I wanted to lay out some guidelines. But first, a story…
When Grendel Couldn’t Heal Herself
As I wrote about in this post, Grendel the Mojo Pup recently fell off the bed. Initially, she picked herself up, brushed herself off, and went about her merry business. My six year old Siena has been intentionally brainwashed to believe she can heal herself and so can Grendel (those empowering positive beliefs downloaded into her subconscious mind will stay there for the rest of her life unless she consciously reprograms them, and I am very mindful that I want to make sure she knows how much power she has to heal herself, rather than programming her to believe she must always seek help outside herself.) So, because of her programmed beliefs, after Grendel fell, Siena kept saying to her, “Grendel, you can heal yourself.”
Then, four days later, after Grendel had been progressively improving, she woke up severely short of breath. As we were racing her to the vet ER, I was explaining to Siena that although I believe it’s almost always possible for the mind to heal the body, sometimes all of our best efforts to make this happen leave us still sick. And because we want to ensure that we’re doing everything we can to optimize our chances of getting well, especially when a life may be at risk, we often need to seek outside help.