Sunday, February 21, 2016

Are our Expectations Realistic?

I recently read an interesting blog post by David Zacharias. He is a physician, and his reference in the title to "Patch Adams" caught my eye. Almost 20 years ago Robin Williams played Patch Adams in a touching comedy. I don't know about you, but I miss Robin Williams. 

Dr. Zacharias describes a lecture during his medical school experience, in which Patch Adams presented "with long blue-and-white hair and handlebar mustache" dressed in "over-sized fish-print pants, a loose-fitting clown shirt, and a single earring fashioned out of a bent fork."

Dr. Adams was there to inform and educate. He provided background on medical professionals' efforts to bring care to the masses, with the accompaniment of humor and compassion. Dr. Zacharias describes that Patch left behind "starry-eyed, first-year medical students ready to change the world."

This is the backdrop against which Dr. Zacharias contrasts his perspective a few years later. He found himself "spending 'the best years of my life' striving to be productive in a giant money-making machine called U.S. health care." He lamented the existence and effect of "an impersonal system overcharge(ing) for services that ultimately make little difference, particularly for an aging population." His perspective may be familiar for some of the rest of us. Are we making a difference?

Dr. Zacharias describes an assignment in which he participated providing "anesthetic care for the surgical resection of a highly invasive tumor in a fragile, deaf, and demented woman who was 100 years old." He spent all day on this case. He found himself reflecting on "how a fraction of the tens of thousands of dollars that would be spent on her hospitalization could easily go towards giving her years of the best home health care money could buy." 

He says that care is provided to patients, motivated by incentives and practice foundations that are difficult to understand or explain. Doctors provide care to others that they would not accept for their personal treatment. Doctors go along with "commercialized medicine with little consideration for the collateral damage created." He claims that "the U.S. is a world-leading example of what low-value health care looks like."

Fortunately, Dr. Zacharias has something we all need from time to time. He has a mentor. He describes how he wrote a letter to Patch Adams, and shared his perceptions and doubts. His mentor responded and reinforced the potential for doing good in the world; he encouraged Dr. Zacharias to believe that change and real progress is possible. 

As Dr. Zacharias reviewed some books Patch provided, he concluded to disagree with the perception that "burnout is inherent in medical practice." He takes exception to the conclusion that “'progress' has become synonymous with 'advances in technology.'” He notes that "greed is one of society’s worst malignancies, and it appears to have metastasized to every corner of the earth." 

Instead, he advocates that a fundamental key is for doctors to be compassionate. He sees their role as providing comfort both in life to the extent possible and in death when that time is come. This he says is the key to fighting the "rise in physician burnout, depression, and suicidality." He laments that young doctors are disillusioned. I do not doubt his conclusion or his sincerity. I would point out, however, that this is not limited to doctors.

Dr. Zacharias laments that "young doctors are increasingly disappointed by their profession," but I would suggest that young people are increasingly disappointed in many chosen fields and professions. This is not a medicine crisis, or at least it is not only a medicine crisis. Dr. Zacharias found strength through his mentor's advice to change his career path and find a vocation in which he found fulfilment. 

That is the key, regardless of education, profession or vocation. We all work to earn a living. But more importantly, we work to bring value to time. Are we helping people, the community, the system? Or, are we cogs in a wheel that we do not appreciate, understand or believe in? Each of us must answer that. It is hard to find fulfillment in the life of a cog.

The key to our personal well-being is not in the perspective of others, but in our own appreciation of what we do and what we contribute. Feeling that we are making a difference is rewarding. I'm not saying I wouldn't like a new Ferrari, I'm just saying there are other things that can be more rewarding. If we focus our efforts on what is right and what serves, we should be able to find reward in that. 

Henry David Thoreau is said to have lamented "it is not enough to be busy. So are the ants. The question is what are we busy about?" Are we creating value, building, improving something, someone, somehow?

Dr. Zacharias "encourage(s) every one of us to discover for ourselves what that magic is" that provides us fulfillment and reward. I join that sentiment and appreciate Dr. Zacharias' perspective and thoughts. He and his blog post made me think. I hope I have done the same for you. 

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