I am writing this commentary in response to a seminal opinion piece published by Dr. Donald M. Berwick, of the Institute for Healthcare Improvement in Boston, Massachusetts, in the online edition of JAMA, entitled “The Moral Determinants of Health.“ In light of recent societal events, and the moral reckoning that our society has commenced in regards to issues surrounding racism, inequality, and injustice, this article is of paramount importance to our profession, and indeed, our society at large. I strongly believe that it should be read by all who serve in the profession of medicine. It is not often that we, as physicians, are asked to take such a profound moral inventory, but it is clear that the current state of our nation demands such an introspection.
Dr. Berwick’s article is an excellent summary of the upcoming tasks at hand for the profession of medicine. Perhaps it is this very moral imperative that will not only make our society a more just and equitable place, but will also rescue medicine from the malaise of physician burnout and loss of physician autonomy. Perhaps it is no coincidence that as the profession of medicine has been subsumed by the “health care industry,“ dominated by those in the legal and business fields, that societal health has continued to degenerate.
The physician as healer, a historically sacred and profound role, has become almost an anachronism. In many ways, we as physicians have been reduced to the role of mechanic, without the time or space to re-expand our rightful role as leaders in all aspects of society, both humanistic and scientific. We seem to have relinquished our political impetus and left decision making at the governmental and societal level to those who have no idea what it actually means to be a physician, let alone a human being.
Fortunately, it seems that the tide has begun to turn, on both the personal and corporate level. To behold the suffering of vast swaths of society is a call that we can certainly continue to ignore, but at great personal and professional costs. Those costs are now evident. There is a moment of decision at hand and who else but members of our profession are better equipped to make the necessary changes, with our intense knowledge of both the scientific and the humanistic? Who else on a daily basis sees first-hand, through the self-narrations of our patients, the struggle and inner workings of systemic racism and overall injustice?
It is my hypothesis that the ongoing malaise in medicine can be traced back to these exact factors, witnessing first-hand the quantity and quality of suffering and poor health, and at the same time being largely unable to do much about it, as competing business, political and legal interests continue to siphon off our resources and exploit the hard work of all health care workers. Could it be, through the greater societal program prescribed here by Dr. Berwick, that we physicians can ultimately find our way again, and restore our collective passion? I believe so. And it will require all of us to wake up to this fact and mobilize on all fronts, with the same courage that we approach the care of our patients, even in the worst of times.
Bearing witness to the actual and ongoing “American carnage,” as eloquently laid out by Dr. Berwick, invites nothing less than a total moral inventory of our personal and professional lives. I, for one, will be taking this inventory for some time to come, and I hope to someday be involved in the healing that needs to occur.
Adam King Skrzynski is an infectious disease physician.
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