The Western health care system is broken. Nobody can dispute this. This doesn’t mean Western medicine hasn’t made miraculous strides in treating acute trauma, saving lives during emergencies like heart attacks and strokes, preventing and treating bacterial and viral infections, replacing damaged joints and organs, and optimizing medical and surgical techniques to repair what is broken or diseased in the body. If I’m in a massive car accident, get me to a Level 1 Trauma Center . . . please. If I get a raging case of pneumonia, give me the antibiotic—STAT. On behalf of patients everywhere who have had their lives saved and transformed by such advanced technology, a huge thank you to those who staff these ER’s and offer such life-saving treatments.
In 2010, my soul brother Nick Polizzi dared to take eight sick people who had failed to respond to Western medicine to the Amazonian jungle to put them under the care of three shamans. They filmed what happened in his documentary The Sacred Science. The trailer for the movie recapped the results (cue dramatic music)—“Five will return with real results, two will return disappointed, and one won’t come back at all.”
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.