To the medical school graduating class of 2021:
As I write this, I imagine a younger version of myself sitting next to you, not knowing, like you, what will come next.
I worried, during that anxious period between graduation and the start of residency, whether I was up to the physical and mental tasks of being a physician: the long hours and the intellectual requirements of practicing medicine. What I learned was that the most important challenges would be emotional, ethical, and philosophical, tests of the spirit and soul rather than of the body and mind.
I’m writing now because I feel we’ve reached an inflection point in American medicine. As the country — and hopefully the world — emerges from the darkness of the Covid-19 pandemic, it’s time for those in health care to address certain realities. Letters of this sort are usually filled with soaring rhetoric, exhortations to devote yourselves to the healing arts and commit completely to this noble profession. I am in favor of all that but have a more somber message.
To say that health care practitioners are living through a unique time would be the understatement of the century. Perhaps only our ancestors who lived through the 1917-1918 influenza pandemic, which killed an estimated 50 million people around the world, can say they went through something similar. During the coronavirus pandemic, many of you were called into duty prematurely. You weren’t ready. Don’t feel badly though. Neither were those of us who had decades of medical experience. And neither was our health care system. We got caught flat-footed in ways that you and I could have never imagined.
As you begin your residency programs, I offer three lessons I hope you’ll keep in mind as you enter the post-pandemic medical world. And I’ll finish with a plea.
One. As the first graduating medical school class that experienced the full force of the devastating Covid-19 pandemic, know this: You are joining a beleaguered, but not defeated, health care workforce. But you can help reenergize these folks. You will be the first generation of physicians to know, through your own observations and experiences, that doctors can’t take care of other people if they can’t take care of themselves. You have seen what that looks like and I hope you will avoid what so many older doctors didn’t — disillusionment with the job, the profession, the work environment. This phenomenon has been popularly called burnout, though that’s a poor term for it. It isn’t generally caused by some sort of internal problem unique to the clinician, but most often arises due to external forces: hospital politics, bad health care policies, the electronic medical record, and, yes, the depletion of empathy after seeing patients die one after the other.
But even as our emotional PPE has been stripped away, discarded like the paper gowns and N95 masks we use to protect our physical selves, we are left with a stark reality: The health care system doesn’t work for patients and it certainly doesn’t work for clinicians. That reality is an unwelcome graduation gift to your generation of doctors, and it will be up to you to figure out how American health care can regain its footing. It will be a tall order, but the pioneers in American medicine who developed cancer treatments, heart therapies, organ transplantation, and, more recently, coronavirus vaccines, faced tougher odds. We can get miraculous things done when the health care system gets out of their way and lets brilliant minds flourish.
Two. We learned (again) that individuals and communities with fewer resources, fewer connections, and less access to health care were disproportionately affected by the pandemic. It must be acknowledged that many of these individuals had darker skin than mine and, at least statistically, yours. For people of color, the pandemic hasn’t been just tough, but devastating. People of color lost their health and their livelihoods in numbers that were disproportionate to the rest of our society.
These disparities are not new, although surprisingly many in the public are hearing about them for the first time. But people in health care have known about them for decades, well-described in research studies pertaining to nearly every facet of medicine.
After the pandemic, we can no longer deny that, if we ever could. The data is convincing, the report card is in, so the time for studying the problem is over — the time to act is now. You are the physicians who must lead this effort. Graduates, do what you can to address this injustice, through your actions in your clinical practices and in your administrative roles. We need one health care system — not one for white people and another for people of color. My generation can help, but we haven’t gotten the job done. You must. It’s the right thing to do — get to it.
Three. We need to put humanity back in health care. The U.S. health care system — which is really not a system at all, but rather a fragmented set of profit centers — has become soulless, an unruly behemoth that is neither efficient, equitable, or manageable. This uncomfortable truth is attributable to many factors: insurance companies dictating patient care, overscheduled patient encounters in the clinic, and consistent placement of profit over purpose, to name just a few. Patients need their doctors to treat them and provide therapies known to work. But they also need us to hear their stories and understand who they are, not just what diseases they have. We need to spend as much time hearing these stories as we do tending to the electronic medical record.
I said I would make a plea at the end. Here it is: Write down your stories about your work, its trials and tribulations, its successes and failures, and lessons learned from patients and family members and caregivers. Anywhere will do: write them in a journal, on your phone or notepad, even on a coffee-stained napkin. Then tell them — to your friends and family and, if you’re brave enough, to the public. These stories can benefit you, the writer, as a form of catharsis. But they also enrich the reader who may be another health care worker, a patient, a future patient, or a family member or caregiver. Another reason for writing is that these stories can be the hypothesis-generating foundation for what could someday become new therapies or new ways to use old ones.
But perhaps the most important reason for writing is that when we tell stories about real people who, when interacting with the health care system, suffer indignities, when we reveal disparities, or when medical errors that harm real people come alive on the page, we are putting human faces on events and statistics that only stories can reveal and possibly preventing these injustices from continuing. A data-laden PowerPoint presentation will never accomplish that.
I leave you with this as you embrace your new profession, your new life path, your new mission: All of us need to hear from you on this journey. Tell us what you think and feel through your writing, your pictures, and even through your social media posts. It will help keep you healthy and, as a result, the rest of us healthy.
David Weill, a 1990 graduate of Tulane University School of Medicine, is a transplant physician, principal of the Weill Consulting Group, former director of the Center for Advanced Lung Disease and the lung and heart-lung transplant program at Stanford University Medical Center, and author of the memoir “Exhale: Hope, Healing and a Life in Transplant” (Post Hill Press, May 2021).
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