We Have Built a Sickness Care System Rather Than A Health System
We have designed that system for the convenience of practitioners, not patients: Convocation speech delivered to graduating MDs at the University of Manitoba on the receipt of an honorary doctorate.
Mr. Chancellor, Mr. President, distinguished guests, soon-to-be MDs and their deeply indebted family members. I’m touched and humbled to receive an honorary degree from the University of Manitoba. Thank you for letting me share this special moment with you.
I’m not a doctor. I never will be. I’m a lowly journalist. I tell stories.
For almost 30 years I’ve tried to help Canadians understand their health system and their medical care.
In that time, I’ve seen tremendous advances in medicine and I’ve met, quite literally, thousands of health professionals, from students to Nobel Prize winners — and patients, from those with rare genetic mutations to those with everyday ailments, from those cured miraculously to those who died needlessly.
Today, I’d like to take few minutes to share some of what I’ve learned from telling their stories.
One of the greatest privileges in our society is to have the letters M.D. after your name. Those two letters confer great power. And with that power comes great responsibility, to quote Voltaire — or Spiderman, depending on your literary predilections.
Shortly, you will be taking the Hippocratic oath. You’ve probably all heard that it says: “First do no harm.” It doesn’t actually – that’s just bad media reporting.
But it does say a lot of important things. I think the line that matters most in the oath is this:
“Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient.”
Sadly, too many physicians fail to honor that part of the pledge.
We have built a sickness care system rather than a health system. We have designed that system for the convenience of practitioners, not patients.
Modern medicine has become so specialized that many physicians treat specific syndromes and body parts, and the patient herself gets lost in the process. We have filled our temples of medicine with such bedazzling hi-tech tools that we’ve forgotten that we should treat people where they live.
In our desire to cure, we over-treat.
We fail too often to say the three most important words in medicine: “I don’t know.” We see death as a failure, instead of aspiring to make patients’ comfortable and at peace at end-of-life.
In our unrelenting quest for efficiency and measurement, we too often lose sight of what really matters. The patient.
What does your patient want? What are his or her goals? Those are the questions that must guide your practice.
For some of your patients, the goal is to repair their acute woes, to help them live long. But most of your patients will be older, and have a number of chronic conditions and be nearing the end-of-life. Their goals are different.
They’re not going to be cured. You have to focus on their quality of life.
They want to be at home. They don’t want to fall. They don’t want to be in pain. They don’t want to be a burden. They don’t want to be alone. They don’t expect miracles – but they would like respect.
They don’t fear dying. They fear losing their autonomy and their dignity. They don’t care about your metrics, or your age-adjusted mortality rates, or your fancy new genomic test. They want to be listened to, and heard.
We hear a lot these days about personalized medicine, about drugs and treatments that can be tailored to specific genomic and epigenetic markers. But you know what people really long for: personal medicine, not personalized medicine.
They crave a human connection. Not just care, but caring.
The very best medicine you can offer your patients is a listening ear. The very best treatment you can offer them is a compassionate heart.
Now you may be sitting there thinking, this is all feel-good nonsense. It’s not. The more sophisticated and complex medicine becomes, the more the basics matter.
What did you learn in medical school? Anatomy, biochemistry, genomics, countless mnemonics to help you remember bits of knowledge; you know how to deliver babies and treat cancer and diabetes and depression and asthma, take out people’s appendix and do MRIs and PCIs, and countless other things.
What you’re going to learn now, in the real world, is that physical woes are the least of patients’ worries. Their health problems aren’t strictly caused by mutating cells, opportunistic pathogens and poor genes, but by poverty, lack of education, poor housing, stress and social isolation.
You’re going to, sooner or later, learn humility. And, the earlier you do, the better the doctor you’re going to be.
In this, the Internet age, we are drowning in information, but starving for wisdom. I urge you, as you forge long, successful and prosperous careers, to not just be smart, but be wise.
In every interaction you have, embrace the ancient wisdom of Hippocrates: “Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient.”
André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.