I am a physician who was raised and trained in the traditional medical system of my time. As medical students and resident doctors, we learned about diseases, drugs, and procedures. We perfected how to take a history from our patients using open-ended questions that still pointed to the pertinent positives, and how to do a physical exam to allow our patient’s body to speak to us in a different language. We enthusiastically learned to look and listen to any body fluid or X-ray image we could reasonably obtain for more clues. This is traditional medicine from the point of view of a medical doctorate.
But there were more critical, if not more oblique, lessons. With the long hours and even longer nights, we learned to be service-oriented leaders. The body became a great mystery to solve, the mind even more mysterious, and while none of us ever found the soul in the gross anatomy lab, we learned quickly at the bedside that the soul was there somewhere. We could, after all, feel it leave the body as we learned how to say, “Time of death: 1739.” None of us will ever forget the room and the faces that looked back at us the first time we uttered these words.
I carried all these lessons with me as I sat in a meeting of administrative leaders who were part of our large and corporate health system. We were welcoming our new heart failure specialist. I stared at a PowerPoint slide with a pyramid shape used to describe how this new heart failure center of excellence would serve patients. At the base of the pyramid were the patients who had mild symptoms of heart dysfunction and only needed a few drugs to take to manage their symptoms. The pyramid climbedupward with increasing levels of medical intervention until you reached the pinnacle of the LVAD or left ventricular assist device. This device is implanted into your heart and pumps your blood around your body for you because your heart can no longer do the job. A miracle of modern medicine for those of us who felt like we had lost a war each time we pronounced “time of death”, and a great source of revenue for those who cared about the bottom-line of an extensive health system
After over 25 years in medicine, I have seen this change happening in the background. It has changed from a ministry- a ministry that doctors are still taught- to a profit-oriented business. Physicians like me still practice the ministry of the body, mind, and soul at the bedside with pride, but now, there is a force hovering thickly around us that does not see it the same way. Instead, some others started to see us as the widget makers on an assembly line. We were told to work harder and faster and be more amicable for those good reviews to maximize billing and revenue. We physicians all shrugged and let a lot of it run in one ear and out the other or swatted it away like an annoying mosquito because when we were with our patients, it was still a ministry to us. Alone and face to face with our patients, practicing our calling, the rest seemed to be paperwork by very peripheral people.
But that day, in that boardroom, I stared at the pyramid of increasing medical interventions and saw the patients. I saw the money coming out of their pockets, their graying skin, and their short breaths as they tried with increasing futility to get the oxygen to walk a few steps. I saw their grown children with worry on their faces and the renovated homes with hospital beds on the first floor because climbing stairs was an impossibility. I saw this pyramid for what it was, and I wondered, “How can I possibly keep myself and everyone I love as far away from the pyramid as possible?” In a modern day healthcare system, health has already been lost when you step in the door.
It became clear to me in that singular moment, that our healthcare system did a very important, job of treating disease. Treating disease lends itself to business. But caring for health is not a good business in this model. Healthy people do not use drugs or procedures or need LVADs. We who are physicians can tell you that while it will never be profitable in the way of a corporate business spreadsheet, it is an integral part of our heart’s calling. It is our ministry.
This is the story of the seed that was planted that day in my mind. A seed that I wanted to nurture and feed and grow into a new kind of American healthcare system that would, at its best, minimize the need for disease treatment as much as possible. I stood 25 years ago in a still clean and starched white coat with my hand raised up and promised to “first, do no harm” to you; my life’s calling.
