Reed and I are biking in Vermont for a week this fall. He encouraged me to trade in my old hybrid bike with its upright position, wider seat and wide tires. I calculate the bike is about 30 years old. That is very old by Reed’s standards, someone who has spent his life in the industry and gets new bikes every two years or so. Turning the wrenches at a Trek shop brings Reed a discount and I now have a new Trek road bike that is light weight with a narrower seat and disc brakes.

Learning to ride the new bike isn’t as difficult as learning to ride period, but it requires some patience. I am leaning forward instead of sitting upright and the tires are thinner. I miss sitting straighter and I have to figure out where to place my hands, so it works for both my back and using the brakes. The balance is different and takes some practice, requires time for the new muscle memory to become familiar, finding the rhythm of when to shift on the uphill and brake on the downhill, how and when to pull my foot off the clipless pedal so I don’t topple over.

There have been adjustments for Reed as well. As someone who’s had a need for speed all his life, he has slowed down. We share a purpose—the ride together—and a common goal or destination. The equipment will get us both there. He’s smelling the flowers more, I am learning new muscle memory. We are figuring out our shared rhythm.

With the Rhode Island move, I am part of new medical practice. This has its own learning curve. Patient care is patient care, but the electronic health record is a different version of one I’ve used before and less user friendly, the referral specialists are all brand new, and nursing responsibilities are different. Irrigating ears hasn’t been a duty for me since I was a resident. Although my clinic provides good care, doctors and medical assistants operate as individual teams and there isn’t much collaboration across the clinic. In fact, there isn’t really a shared purpose or vision across the entire health system. We talk about a patient-centered focus, but pressures of productivity and lack of staff support make that a token goal and it is difficult to keep the patient at the center with so many competing demands. My colleagues have done what anyone does when they are under attack: hunker down, focus on the patient, do the best s/he can on his/her own, and try not to burn out. That means no shared purpose or rhythm. Unfortunately, that won’t get us to a common destination.I think this is symptomatic of health care today. The profit motive has made the beat hard to hear. In fact it is only getting worse with efforts like Amazon, Berkshire Hathaway and JPMorgan. There is opportunity to cut costs and improve value for employees, as well as money to be made. It all creates cacophony.

I’ve written about the health care mess before. I don’t advocate returning to the days of Norman Rockwell’s doctor. Life has gotten too complicated. Medicine has broadened its charge to include prevention and managing a variety of chronic diseases, both important. Patients today have many challenges that medicine cannot fix. Poverty, lack of access, and unrealistic expectations of what is curable. These are societal problems that go beyond health care’s charge. So does the lack of planning that results in too many physicians in some regions and not enough in others; too many MRIs so centers  perform unnecessary tests to make their budgets. Insurance ratchets up the need for prior authorizations to try to manage it all.At some point we as physicians need to call for an honest societal discussion about a shared purpose and goal. Until that occurs we are operating in survival mode. And the US will continue to spend lots of money on health care at the expense of education, environment, safe roads and other essentials. It is long past the critical time to find the beat and have the conversation needed to begin drumming a shared rhythm.