Tuesday, November 8, 2011

Occupy Our Health

I saw the fog rolling in. No! no, it was not rolling in as much as it was just embracing the foliage. The trees, far away, first disappeared slowly in the midst of this moisture and then as the visibility decreased, the fields in front of me began to recede into this peaceful quiet of the grey goo –a slow occupation. As I watched the mist overtake, I could see the Hibiscuses and the daffodils in their colorful beds strain to reach for that ray of sunshine hiding behind the clouds.  Straining equally in my mind, I realized how, with such simplicity and grace, a single idea can adorn and then overtake a thought. I mean, how from a nuance, an idea or a dream is born and equally from nothing emerges the kind of thinking that catapults a single thought into the mainstream of society to transform it- like the straining daffodils through the mist of fog, looking for answers find it in the sunshine.  Healthcare is ripe for the occupation by intelligent thought, replete with reason and depleted from diversions.

It may have happened just recently. It started as a slow rumble and grew to the current white noise everywhere. Medicine and its practice is changing as we speak. There is a cacophony of disparate voices clamoring for expression and delving through the cyber universe of hash-tags and ampersands and their collective spirit seems to be emerging to “fix” a badly wounded entity. Medicine lies bleeding at the altar of bureaucracy and on the pyre of finger-pointing and anger. It is being defanged against the viciousness of disease. It has been de-clawed against the predatory advances of fiscal motives and dethroned from the nobility of its purpose; from what should be done to what ought to be done.

Somehow there exists an irony in all this, the irony of reticence and broken expressions of a fragmented society that seems to pervade the medical atmosphere today. Medicine is in the throes of loud voices of self-proclaimed experts, pushing and pulling the torque tubes of momentum for their own self-satisfying needs.  Everyone, it seems has an axe to grind. For that fifteen-minute of fame they will sell their souls and be damned, and not care. And as always from the days of the “Snake-Oilmen” who, still abound today with only their hats and long coats changed to slick hair and pin-striped suits, the selfish motives remain as their pervading mental flotsam. Their expressions are disguised to beguile. Meanwhile the doctors inundated with answering to the needs of patients and monitoring the regulatory burden of this and that and keeping up with the daily advances in the field of medicine are left whimpering as to what is real. So what is real? Do we know? Is there an answer to all these pleadings of help? Or are we just prey to the predation of the slick and the slippery? Is truth the scarce commodity of today?

To find that truth, first we must find the root-cause and then try and fix. Nowadays, the rational thought is disguised in some artifact of graphs and tables, reason is bled from the real and transferred into some fog of probability that leads the essence of patient care to confusion. The despair although palpable in our souls is restricted and confined by the corporeal bounds of our being. We must fight the urge to languish in this despair. We must teach ourselves the concepts that help and not detract from helping people in need. We must question the new concepts if they are steeped in some form of snake-oil slipperiness. We must start to question the very essence of all dictates that try to modify or mollify, not because of the potential of a change but because of the underlying motive. And if the motive and change weave together into a common thread of betterment for all humanity then we must understand and stand by such progress. Calling something “progress” is not always progress. True progress is the cumulative and positive effect of an action. It is the outcome of a motive. It is the endgame of all plays. It is for the better for all of humanity- that is progress! Marie Curie, Louis Pasteur and Watson and Crick come to mind.

And yet as time ticks away, often the purchase of frustration grows, as does the restlessness and the anger. Today, such intemperance finds itself in the form of cyber-chats. Minds full of ideas, disparate or similar find an expressive outlet to jointly grow the foundations of resuscitating the nobility of this profession. Yes, that time has come.

Patients, doctors and nurses all seem to have come to find the common ground for a cause to serve themselves and the future generations, the care and comforts that human dignity deserves. It is not the wail or the cry of want but the distinct and precise nature of the care giving to benefit the individual in need. Realizing that medicine is not all about monetary benefits but about the rewards of seeing the sick get better and those doomed to death finding life in this care, for that, we must strive for the better angels in us all. As physicians we strive for wisdom of knowledge and patients equally need to be understanding of personal responsibility as well. Consumption or over-utilization of limited resources will hamper care for all and this applies equally to physicians as well. We must educate the people about self-governance. Teach them that responsibility of moderation and prevention far exceeds the benefits of retrospective emergent/non-emergent care. We are in this together, all of us.  We are at the threshold of such a moment once again in history. Let us be firm in our resolve and confident in our future. Medicine and self-responsibility are all we have between life and death- keep truth in the former and desire in the latter.

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