It won’t be long till our country, as a collective whole, has the opportunity to choose new leadership with hopes of generating the momentum and strength to bring about meaningful change in the way we conduct our lives. Rather, this is the hope for liberal voters who recognize the perilous state in which our country currently resides. The United States has lost much of the good will and influence it once had as a benevolent pro-democracy world leader. The current administration has fostered a more reactionary and radical international atmosphere with no conclusive removal of terrorists threats (partly from creating inspiration for new terrorists who despise what they see as American imperialism and interference). The domestic economy is in shambles with a shortage of employment opportunities for young Americans. Our dependence on foreign oil is pressuring and hindering domestic affairs and business and even personal travel. And, of closer interest to me, the deterioration of our health care system and its failure to fully accomplish in its evolving mandate (one that is being adapted to a new century and may outpace the mindset of some physicians) has finally garnered enough attention, anguish, and energy to push forward much needed health care reform. The other side, conservative voters, would like to believe that the hardship and troubles of the past eight years simply represent a “growing pains” period in the transition to a “Pleasantville”-style America of yore: in their eyes, things aren’t that bad (which is true, because their eyes are generally not turned towards those Americans who are in need of help or who are suffering most from these hard times), and things will only get better the smaller their worlds become.
One of my most shameful confessions is that I was once quite conservative in thought. Despite the relatively “liberal” way in which my parents raised me and my brother (free access to TV, books, movies and the Internet; considerable world travel; great emphasis on education), the conservative nature of socially-mobile immigrant thought was also imparted upon me. My hard-earned dollars are my own; why should I spare a cent for the lazy bum who would most likely spend it on drugs or alcohol? My parents came to America with a couple hundred dollars and their suitcases and were able to work their way up through socioeconomic ranks from an entry point near the bottom; why can’t people on welfare get a grip and do the same? Why would I want anyone (including government) interfering with my affairs when my parents fought so hard and long to finally achieve political freedom by becoming American citizens? It took several years of education to shape and finally break through this thought cycle, but nothing has dispelled the placating conservative myth greater than my entry into the field of medicine and an in-depth retrospective look at what brought me to this point. This is not to say that doctors are universally liberal (in fact, many are quite conservative, and it is a conservative doctor whom I respect greatly who inspired this post), but the position of being rapidly and repeatedly exposed to the lives of thousands of others, their troubles, their successes, their joys, and their suffering, questions more than a few underlying assumptions of the world and its people. Every day I play the role of the detective, storyteller, and scientist as I methodically comb through the medical, familial, and socioeconomic histories and realities of each of my patients. Repeated exposure and the perception of repeated “failure to thrive” can make medical professionals quite callous, but this tendency runs contrary to that which allows us to truly be healers rather than just mechanics of the body: the mandate and imperative to use compassion and empathy to treat the body and mind, and sometimes even the soul, to the best of our ability. I would go so far as to argue that doctors who claim that physicians should only treat the body generally lack the strength, capacity, or will to do more. Humans are complex, interactive, social beings, and physicians need to address them as such with a “multidisciplinary” approach that is generally referred to as the “art” of medicine. I personally find it hard to believe that one can fully accomplish this and still maintain a largely conservative world view.
Unless, of course, the person’s world view is small. Therein lies my best answer to the nature of the compatibility of intelligence and conservative thought: it is possible to be intelligent, well-educated, and conservative, but this sort of mind lacks true exposure to a broad range of human experience. It is complacent. True exposure requires more than CNN or Fox News, the NY Times or the Wall Street Journal or the Economist. It requires more than classes at Harvard or a few volunteer experiences. It requires more than sight, hearing, or smell. People find exposure in many ways, but for me, medicine has thus far been my path through the compendium of humanity. It is possible to travel this path with blinders or “eyes wide shut,” but I have tried to keep mine nonjudgmental and objective. Whether successful or not, it has given me the chance to share both great joy and great sadness, anguish and ambivalence, clarity and confusion. In what other profession besides medicine (whether as a doctor or nurse) do you spend so much time wading chest deep in some of the most intense, critical moments of the lives of others? Many people would disagree about my assertion of interpersonal engagement as being the measure of human experience and would argue that a “broader,” “higher,” ten thousand foot high view of the world is more ideal or accurate for assessing the state of humanity and its truths: personal interaction is subjective, emotional, and lacking universality. I think these people are lazy and lack the willingness to look another human being in the eyes and truly listen to and share in their story as if it were the person you love most speaking to you. I think these people are unwilling to engage the suffering or accept the emotional expression of others, whether it is because of their own internal fears and insecurities or because of a lack of strength to not falter and collapse under the weight of another person’s troubles. It is thought that there may be a limit to the number of human beings a single individual can develop meaningful relationships with; this, however, says nothing about the number of people an individual can meaningfully share experiences with. I believe this, I know this, because I am going to be a doctor, one of many types of people who are willing to take the heat.
With this transformation of mine in mind, I believe that our country is at the cusp of great change with respect to medicine and health care: I see this as the beginning of an era when physicians regain influence and leadership capacity by taking ownership of the change that needs to happen, and I see this as the time for reforming some of the fundamental principles of American health care that have left so many people to suffer and languish in a perverse system. I find it interesting that people talk about “perverse incentives” as a disadvantage of pay-for-performance reimbursement in medicine, and yet we forget to describe the daily function of many insurance companies, HMOs, pharmaceutical companies, and other entities in health care as “perverse” or “operating under perverse incentives.” I think that people hold physicians to a higher standard of conduct that I do not find inappropriate. However, I think in order to make that worthwhile, I think physicians need to step up to the plate and engage in the dialogue of change: reform in health care needs to happen, and if it is going to happen, why not be at the helm (or at least, one of the leading parties involved)? Health care is currently functioning in a state that seeks to exclude physicians from all management and policy decisions; how can this possibly be ideal or even acceptable, whether for doctors or patients? This may be acceptable to a complacent mind, but it is not acceptable to mine.