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Restoring the lost heart of medicine

I am going to criticize everyone who has spoken yesterday and today and everyone in the audience.” That’s how Dr. Victor Montori started his closing keynote at the 2018 Lown Conference.

Montori, an endocrinologist at the Mayo Clinic and founder of the advocacy group The Patient Revolution, was not arguing against working for affordable, effective health care. He was questioning the language we use to describe health care reform – the type of language that he says reinforces health care as an industry rather than health care as an art. 

“We shouldn’t talk about care as a productdelivered by providers to consumers who are activated, ” said Montori. “By treating health care like a business, we lose meaning and connection with patients.”

Rebuilding the sacred space

Montori goes deep into the problems of what he calls “industrialized health care” in his book, Why We Revolt: A Patient Revolution for Careful and Kind Care. Lown Institute Vice President Shannon Brownlee recently reviewed Why We Revolt in The Washington Monthly describing it as a “slim and beautiful book” that reveals “the ways in which the industrialization of health care, rather than making it more efficient, has instead corrupted the mission of medicine.” 

From Brownlee’s perspective as a health care journalist and think tank leader, Montori’s book is a breath of fresh air. Too often solutions to health care dysfunction just put more onus on patients to work within a broken market-based system, rather than challenge the way the system actually works. Montori addresses the problem at its source, calling on patients and doctors to have unhurried conversations, to rebuild the sacred space where doctor-patient interactions occur.

A negative and impossible environment

 

Lown Conference participant and Right Care Alliance member Mary Mack was also inspired by Montori’s book. In Why We Revolt, Montori contrasts the desire many health care workers have for the streamlined efficiency of airlines with the impersonal relationship between pilots and passengers. Montori is shocked that his colleague would want a system where  the patients, like airline passengers, are all a “blur.” But as Mack writes in a blog post at The Patient Revolution, the flight home prompted her to think about the ways in which the health care system is already like the airline industry. 

On her flight, from what she could see beyond the curtain into first class, passengers were getting “elaborate attention” from the flight attendants – sometimes more attention than they wanted. Meanwhile, in economy class where Mack was sitting, “passengers lacked compassion and understanding for one another,” creating a “negative and impossible environment.” The combination of overtreatment and undertreatment was playing out right in front of her eyes.

Regaining hope

As Montori describes how the health care system has failed patients, he never loses sight of what medicine could be, and the importance of “the privilege that arises from having a front-row seat at the most intimate, sorrowful, harrowing, and joyful moments in the lives of others.”

Take Brownlee’s advice and “read this book to regain your sense of hope for the future of medicine and nursing. Or read it to understand how we can integrate the need for clinics and hospitals that are as safe as airliners and as efficient as Cheesecake Factories with the need to build a sacred space for healing and our healers.”

“Just read it.”