Sunday, August 31, 2014

A Love Story: Longing for What Medicine Could Be



You have to stand for something; otherwise, you will fall for anything.

This mantra played over and over in my head as I reflected while reading Dr. Sandeep Jauhar's new, exceptionally well-written and wonderful book, Doctored: The Disillusionment of an American Physician.



Writing memoirs takes courage. This type of writing exposes you: by sharing yourself openly, you make yourself vulnerable. Being in love is, after all, all about vulnerability--a perpetual state of vulnerability, really--and Dr. Jauhar loves being a doctor.

The roller coaster love journey that he shares in Doctored reveals clearly that he is deeply passionate about medicine, but he has encountered frustrations, undoubtedly. Frustrations that make loving modern medicine quite challenging. Perhaps an impossibility. As a medical student who grew up in a family of healthcare professionals, I've caught glancing blows from these challenges throughout my life. These blows confront you; they test your ability to stand for something--to stand for your values while practicing the art and science of healing. Practicing medicine is an expression of values, ranging from morals about honesty in communications with patients to philosophies about human physiology to ethics about how to do business and make a living. In this memoir, Dr. Jauhar reveals how he has staggered but has not fallen; how he has made decisions that he regrets but has not given up. He still has hope. He has hope that medicine can be practiced differently by doctors (and their healthcare professional colleagues) in the future, in accordance with the values that called them to this profession in the first place. To this end, his book is an expression of what Langston Hughes once famously said, "Hold fast to dreams."

His book definitely helped me thinker further about my personal dreams.

By exposing the frustrations that he has faced in reaching his mid-career crisis as a physician, he speaks indirectly to medical students like me who are doing our best to hold fast to our dreams while growing increasingly saddened and disheartened by the reality that many doctors today are unable to practice medicine in ways that express their values and passions as they envisioned them when they entered this calling that is an honor, a responsibility, and an amazing blessing: when they committed themselves to a life of doctoring.

To be sure, many of the important points that Dr. Jauhar peppers in are old hat for those familiar with the history of the nation's health policy and administration discourse. If you removed the publication dates (and the names of key people and other give-away identifiers) from healthcare policy op-ed pieces in The New York Times and in The Wallstreet Journal and then showed them to me randomly, I would struggle to determine in which decade they were published: whether penned in the 1970s, 1980s, 1990s, or 2000s, it's essentially always the same lamenting, like Groundhog Day. But Dr. Jauhar strings these oft-cited points together thoughtfully, weaving them into his narrative naturally by using examples from his personal life that bring these issues to life in poignant, memorable ways. His book is highly instructive in this way. For instance, he illuminates the dark side of procedure- and test-based fee-for-service medicine that fueled the rise of the Golden Era of medicine while at the same time drove the demise of modern medicine. He accomplishes this feat by telling about his frustrating--and at times unethical--experiences as a moonlighting cardiologist trying to earn extra money just to pay his rent, educational debt, and other basic family living expenses. It's at these times that he catches glancing blows, staggers, and faces a critical series of questions:

What do I stand for as a doctor? I thought I stood for X, but in this healthcare business environment I find that I continue to compromise my values and behave in ways that indicate I stand for Y. I don't like Y. Why am I so perplexed and unable to stand for X?

It's a systems issue.

At Kaiser Permanente, founded by a fringe band of physicians out in the Mojave Desert in the 1930s, the question that undergirded this healthcare system's raison d'etre was simple: Can physicians manage the quality and costs of medicine? Dr. Jauhar thinks so; his emotionally-draining struggles with the business of medicine have convinced him that we need more doctors involved in shaping the quality and costs of medicine actively, rather than passively, because passive participation in the healthcare system leads to desperate attempts to game the system: to, at the margins, blatant fraud and abuse aided and abetted by convoluted rationalizing--by storytelling. And Dr. Jauhar confesses readily the stories that he told himself to rationalize (and attempt to justify) his participation in such unethical business practices, in the very practices that he knows underly many of the cost and fragmentation issues that we continue to face year after year in American medicine. It's this honesty that I respect and admire. He admits to what it's really like to be caught up in this game, playing it while it played him.

In the end, amidst escaping these schemes, Dr. Jauhar still longs, thankfully, for what medicine could be. To translate this yearning into reality, though, the reality is that we need institutions that provide the cultures and environments that support healthcare professionals in expressing their values as healers in ways that make their daily jobs fulfilling. This is not an impractical idealism; this is an absolute necessity if we hope to (1) restore sustainability, (2) revitalize human dignity, and (3) advance the safety and quality of medical care in our nation's healthcare systems.

It is to this end that I devote my medical career; to figuring out how to foster and support the evolution of new institutional solutions to our current healthcare system challenges.

That said, the Ancestral Health Symposium (AHS) is one such attempt; an attempt to foster and support a respectful, reflective (and fun!) forum where our understanding of what it means to be a human being evolves in valuable yet practical ways that help people enjoy healthy, fulfilling lives.

Ultimately, we all have to stand for something, or we will fall for anything. Together, healthcare professionals in partnership with their patients can stand up for what medicine could be:

A love story.

To good health,

Brent

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