Searching for Meaning in Medicine

Clinical medicine, and especially primary care, is in kind of a bad place right now.

When healthcare systems of all developed countries in the world are compared, the U.S. has the embarrassing distinction of spending the most and being the worst.

It’s well-established that our outcomes, including critical metrics like life expectancy and infant mortality, are really bad, and getting worse.

Anyone who has ever been a patient or shepherded a family member through an illness knows that it’s an experience often fraught with frustration, miscommunication, and frank errors.

Why does our system suck?

A combination of factors contribute to our suckiness, including the contradictory existence of both a behemoth, burgeoning insurance bureaucracy AND unequal, insufficient insurance coverage.

One other factor (that hurts alot to point out, but is as true as the sky is blue): The unforgiveable inadequacy of our primary care system.

Yes, as a primary care doctor it stings, but we need to face the fact that we are not doing an even passable job providing primary preventive care to people.

But we toil away within the toxic system, creating work-arounds, becoming disillusioned, and then burning out.

Despite mountains of evidence showing that it works REALLY WELL, we have no widely implemented clinical standards for addressing the essential lifestyle contributors to health. Things like nutrition, physical activity, stress management, sleep, and social support.

Seriously, think about it. When was the last time your primary care doctor asked you what you ate, how much you move your body, and how is your stress, sleep, and social support? And then offered to help and guide you in all of these areas? Heck, just focusing on nutrition alone would have an incredible impact on our nation’s health.

I’ve been searching for a more meaningful medical position for the past year, exploring varied jobs all the way from concierge medicine to non-clinical health information technology.

I especially want to work somewhere that incorporates the practice and prescription of evidence-based lifestyle medicine– this focus on nutrition, activity, stress reduction, sleep and social support (plus attention to smoking and substance use), for both providers and patients– into primary care practice, where it belongs.

I also want to work someplace that calls for connection and kindness with colleagues and patients alike (as described beautifully in Rana Awdish’s immediately essential book In Shock). I’m not sure anyone has this yet, and I think it will involve a complete revamp of how we train our students and residents, which is underway, at least at some institutions. After all, Rana’s book is now required reading for every single incoming Harvard Medical School firstyear.

And, I want to work somewhere that can rethink healthcare delivery, flip it to the patient’s perspective, and provide them what they truly need and want, as described pragmatically in Zeev Neuwirth’s excellent book Reframing Healthcare. Our antiquated office model is not meeting anyone’s needs to any great extent anymore.

But no place has all of these things yet. So I’m still here in the ‘legacy healthcare system’ where I have been practicing for eleven years, and realizing that if I want things to be better, I may just have to change them myself.

This week, I sent my resume to a bunch of the higher-ups in my own hospital, letting them know that if they don’t want to lose me, they better listen to my ideas, and maybe even give me a position where I can innovate.