My dream last night

I just woke up from a wild dream and thought, why not write about it on my blog? As with most dreams, it’s hard to remember exactly what was going on, but I was in another city with my family, trying frantically to pack my bags and go to the airport. But the suitcases were overstuffed, and time was running out before the flight!

We must have been in some sort of motel, and there was a man doing housekeeping, and he showed me a fingernail that was on the floor, and asked if it was mine. I said it was not.

We had to get going or we were going to miss our flight, so I threw away some of my belongings in the trash and we took a taxi to the airport. I suppose we made it on the plane, and back home, although this home was not like the home I know. Several recent college graduates were with me, and I realized we needed to start a social movement. But first I needed to search outside my house – so the others went inside and I locked the door. I took the dog and and a flashlight and marched around, making sure there were no bad guys hiding in the shadows.

Eventually one of the others joined me, and we headed down to an underground parking garage, and I told him, “so here’s the plan. We are going to start a social movement, and an NGO. However, it’s impossible to say that it won’t spin off into a for-profit enterprise…”

And then I woke up. This was five minutes ago. If anyone has read Freud’s The Interpretation of Dreams, you can help me figure out what’s going on.

But what I was planning to write about this morning was on a completely different topic – advice to young doctors.

Match Day just happened, so the 4th year medical students have found out where they will be going for their residencies. And that means the third years are going to become 4th years, and 2nd are going to become 3rd years. Another generation of doctors is being created.

But it’s clear that America’s health care system is very troubled. It’s so inequitable, and focused on hospital-centric care, and most of the power is with the hospitals, insurance companies, and drug companies, not the doctors and nurses. There’s little appetite for systemic change in the United States for health equity, racial justice, community based primary care, and prevention.

And electronic medical records have completely transformed American medicine into a computer-based enterprise. When I did my primary care clinic at Logan Heights Health Center in San Diego from 2008-2011 we still used paper charts. Even during my infectious diseases fellowship at the Brigham from 2014-2015 we were using paper charts to a large extent (along with an old DOS based system called BICS). But now everything is digital, and while it has its benefits, it also has its drawbacks. We are glued to our screens, and our EMRs are often clunky, and we are frequently rushed.

I think the best description of the way forward is actually in a 2019 novel called Man’s 4th Best Hospital, by Samuel Shem. In it he skewers corporate medicine and calls for a new health care based on primary care and humanism. The central lesson Shem attempts to impart is that “isolation kills” – we must stick together and look after each other as we try to survive, heal people, and fix the system.

I think this is quite right. For the graduating medical students heading off to start their internships, for the students just starting their clinical clerkships, and for practicing doctors like me, we need to look after each other. We need to be members of the American Medical Association, state and local medical societies, hospital committees, the American Medical Student Association, and National Medical Association. We also need to join and lead transformative organizations such as Physicians for a National Health Program (PNHP).

Recently, I was recalling my 2004 white coat ceremony at the University of Pennsylvania School of Medicine in Philadelphia. I’m glad I became a doctor, although I’m saddened by the ways that the American medical system makes health care workers sick. I love seeing patients, sitting with them, listening to them, and I hope some day we will be able to organize for a better health care system, one where we aren’t glued to the computer. I truly believe we can get there, and create the humanistic medicine that we need. What do you think?

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