Metamorphosis Medicine—Lauren’s Update Nov 2020
The medicine doctors need to be the doctors Medicine needs.
I’ve thought over the years and in a more focused way during the last year how to monetize the project of helping physicians and changing the culture of medicine: employed positions, physician wellness programs, administration, coaching, personal advisory councils, retreats. The Seed House was intended to be a pilot or demonstration project. At this point, a membership model for this seems like the lowest overhead, simplest format. If 0.1% of physicians paid $15/mo and the same proportion of medical students paid $5/mo, this could generate well over $250,000/year in revenue. Having content relevant to premeds, nurses, nursing students, pharmacists, etc could clearly increase this.
The goal of MM is to help physicians find deeper satisfaction in our work, to realize the humanitarian calling (what I call our original sacred intention), and to feel we ourselves grow, heal, and thrive in our practice. Over my years of inquiry, it has become clear to me that achieving these things requires providing 3 things:
Education that is not included in formal education or even our professional lexicon,
Credible pathways to influence change in our practice environment, i.e. making systemic change), and
Self awareness of the corrosive personal toll that lack of alignment between our inspiration or values and what we practice and teach takes.
Almost any work we do in life can offer the rewards that medicine can, but few professions plunge us into the human condition and our deep interconnection with each other and the world around us with the intensity and focus that medicine does. It should be vitalizing and uplifting, not depleting. I truly believe it is not only possible but essential to realize the gifts of medicine for us and for society. Here’s what has emerged from my deliberation and deep personal reflection:
The Missing Curriculum. On the individual practitioner level, this includes instruction, practices and perspective to address the challenges of work in medicine that fill the interstices between the everyday tasks we perform or are the residue of them. I use the acronym FIRST AID to remind us of failure, fatigue, isolation, rage, sorrow, stress, trauma (primary and secondary), anxiety, inadequacy detachment, disillusionment, despair. The Missing Curriculum calls our attention to these experiences, validates them, and provides ways to mitigate and even prevent some of them. At the very least, it allows us to name them, recognize them, and realize we are not alone with them or that they are inevitable.
Incremental Change. It is not necessary to have episodic, major disruptive upheavals or revolution to achiev, enduring, transformational change. Noticing, making small changes in a steady way that are resonant with our own goals and joy is powerful individually and collectively. In this way, we can gradually effect change without having to take on the industrial medicine complex as a whole. We can chisel away and reshape it through growing awareness and personal commitments that are meaningful to us and sustainable. I recognized all along that doctors have power and can make change once we set our minds to it and exert steady pressure from the place of our passion. I thank my friend Robbie Vorhaus for illustrating this and supporting my own journey to discover and trust the power of incremental change. You can check out his book One Less, One More, which offers a pragmatic, beautiful articulation of this.
Rebalancing Priorities and Personal Practice Prescriptions. The compelling professional trifecta of a career in medicine is the promise of financial security, intellectual stimulation, and meaningful work/worthy undertaking. The financial priorities and attendant focus on compliance and regulation have trumped everything else. Medical science is powerful, but data is in many respects the lowest common denominator of science—a long way off from the pure science leading edge of curiosity and engaging the Unknown. The scientific paradigm that has helped us make great strides in the last 100 years is powerful but has significant limitations, especially for comprehending complex systems. And the heart of medicine, what makes people choose this path rather than a primarily financially generative path (business) or a primary science career, is the appeal of making a difference in people’s lives every day, of intervening, of helping, or prolonging and improving life. These most central, numinous concerns have been pushed to the periphery. The lack of alignment between what we value most and what we are called to do to meet the dominant priorities or are hampered by lack of perspective, habits, and education (The Missing Curriculum). The imbalance and overly narrow definitions of priorities are where moral injury and empathic overload happen. This is a formula for despair. I believe we have to rebalance and redefine the priorities of medical practice as prosperity, knowledge/skillful practice, and the numinous. If we fail to take stock of our hope and wonder as the key drivers of the medical endeavor, we pay a price. Assessing the price we pay for our avoidance is a key to not just accepting but embracing the need for change. Alignment within and among us is empowering and a foundation for thriving. This sets the stage for clarifying our intentions and beginning to write personal practice prescriptions that optimize our opportunities to achieve our dreams and honor empowering diversity. I think this can also pave the way for us to open to awareness of things like how allopathic medicine has failed and often exacerbates chronic disease and allow us to consider things like lifestyle solutions for lifestyle illnesses. Finally, this kind of integration also makes connection and honors interdependence.