(Hat Tip to Dr. John Dunn for this link)
I cried when I read Don Berwicks’s address to the 2010 graduating class at Yale Medical School.
I cried because he urges these new physicians to see the humanity of their patients. Not just to see it, but respond to it and stand up for it. He begins with the story of a woman who contacted him because she was barred from being with her husband outside of “regular visiting hours” while he was dying in a hospital ICU. Her husband complained, “She is not a visitor, she is my wife.”
Berwick writes ―
What is at stake here may seem a small thing in the face of the enormous health care world you have joined. It is as a nickel to the $2.6 trillion industry. But that small thing is what matters. I will tell you: it is all that matters. All that matters is the person. The person. The individual. The patient. The poet. The lover. The adventurer. The frightened soul. The wondering mind. The learned mind. The Husband. The Wife. The Son. The Daughter. In the moment.
I urge you to read the speech. It won’t take very long. It is pure poetry and excerpting poetry never works. There is a rhythm and beauty to it that is lost without the fullness and tempo of the whole thing. It will make you cry, too.
But I cried not only for the story Dr. Berwick tells, or the lessons he imparts. I cried, too, out of bewilderment and frustration over Don Berwick himself. I have written about this before.
Here is a lovely and loving man, someone who treasures the dignity of the people he cares for, who recognizes and honors their humanity and their sovereignty. How could this man be the same one who, as CMS Administrator, advocated locking physicians into an “evidence-based medicine” regimen that treats patients like mere statistics and confines personal knowledge of them to variables of age, race, and gender (like the Dartmouth Atlas does)? How could he push for the adoption of a program that assigns patients to an Accountable Care Organization without their knowledge or consent?
In my earlier commentary about Dr. Berwick, I noted that he was discouraging even face-to-face encounters between patient and doctor. He said standardization of treatment was more important than physician autonomy. He seems to embrace exactly the kind of regimented, bureaucratic rules that he decries in this speech.
Here is the essential conflict in American health care today. Is the patient a slab of meet to be efficiently cooked up in Atul Gawande’s kitchen? Or is the patient a fully-realized human being with a complete range of emotions, abilities, resources, and support systems? The latter qualities have enormous influence on outcomes and should be factored into any treatment plan.
But, more importantly, we have to always remember that the second word in health care is CARE. How can a doctor care for a patient if he doesn’t care about the patient?
At his best, Don Berwick understands this well. But he sometimes seems to have a Mr. Hyde lurking inside his Dr. Jekyll.