We’ve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets – and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win. Hope is not a plan, but hope is our plan.
I said there are at least two kinds of satisfaction, however, and the other has nothing to do with skill. It comes from human connection. It comes from making others happy, understanding them, loving them.
Don’t let yourself be. Find something new to try, something to change. Count how often it succeeds and how often it doesn’t. Write about it. Ask a patient or a colleague what they think about it. See if you can keep the conversation going.
Outsiders tend to be the first to recognize the inadequacies of our social institutions. But, precisely because they are outsiders, they are usually in a poor position to fix them.
I learned about a lot of things in medical school, but mortality wasn’t one of them.
Culture matters. Of course, if physicians are rewarded or penalized for their service and results, the culture will change. But the key values we doctors are being pressed to embrace are humility, teamwork, and discipline.
These are folks that keep people out of hospitals, out of emergency rooms, out of nursing homes. And not only that, they help people achieve more fulfilling lives.
The definition of what it means to be dying has changed radically. We are able to extend people’s lives considerably, including sometimes, good days.
Expertise is the mantra of modern medicine.
When I do an operation, it’s half a dozen people. When it goes beautifully, it’s like a symphony, with everybody playing their part.
If the conversation people think is coming is the ‘death panel’ conversation, that’s a total failure.
If I became just a brain in a jar – as long as I can communicate back and forth with people, that would be okay with me.
Our ideas of what our priorities are shift as we come face-to-face with some of the struggles.
When we lived in a society where we had large families that lived together, especially in agricultural societies like my grandfather and father grew up in, the result is you always had family around to take care of you.
If we took away the ability to put defibrillators in people in their last years, people would be shouting in the streets.
In one study, old people assigned to a geriatrics team stayed independent for far longer, and were admitted to the hospital less.
What is the alternative to understanding the complexity of the world?
And in stories, endings matter.
What about regular professionals, who just want to do what they do as well as they can?
I think the extreme complexity of medicine has become more than an individual clinician can handle. But not more than teams of clinicians can handle.