Seeding Hope
“Give them hope.” That was my charge from the course directors in Gateways, a pipeline masters in science program at Brown University created to increase the diversity of the physician workforce. Started by Dr. Gowri Anandarajah six years ago, the first two weeks of the program this summer have focused on various aspects of the US health care system and the students’ first essay was to write about the top three problems.
I was a medical student forty years ago. My pocket black binder started out 2 times the size of their cell phones and doubled during residency, but likely held one tenth of the clinical information. Everything was paper and carrying some medical charts was a substitute for weight lifting at the gym. The journey from paper to the electronic health record (EHR); the evolution of AIDS from a death sentence to chronic illness; the gyrations from fee-for-service and managed care back to some form of capitation; the array of efforts to chip away at the number of uninsured and to pass some kind of national health insurance . . . Whew what a journey.
The system or non-system still has run away costs. People slip through the cracks. Profit drives much of the planning. Where is the hope? How do I feed the passion and excitement of this diverse group of twenty-somethings as they work to launch a career in health care, hopefully as physicians?
My topic was population health, covering the transition from fee-for-service (FFS) payments to Accountable Care Organizations (ACOs). The alphabet soup of initials could put them to sleep. And fee-for-service hasn’t left us yet!
My methods for facing such a challenge are to do my homework and then sit with the dilemma. Take it to the pool when I swim, to the park where I walk, etc. With the usual dose of patience it came to me. Talk about the curious, ingenious and passionate primary care docs who have made a difference. The Tom Bodenheimers and his work on teams and patient centered medical home. Jeff Brenner and hotspotting. Don Berwick and the Institute for Health Improvement. My former boss, George Isham from HealthPartners and his work with HEDIS and NCQA.
I’ve been reading the book Story Dash! which reminded me of the importance of a protagonist and challenge in a story. Challenges were abundant, and as I ruminated over the years, many protagonists heroes and heroines emerged. But I only had ninety minutes, so I had to limit my stories.
That was how I seeded hope. Stories about several of these health heroes who faced a problem and used their curiosity, ingenuity and passion to craft answers.
Good luck Gateway students. There are an abundance of problems and we need you.