Tom Harkin, a neighbor on San Juan Ridge, was a forester renowned for his breadth of knowledge and depth of practical wisdom. Whether an issue was limbing trees, storing fir seeds, or erecting a shopping center versus leaving the place alone, his advice was always the same: “It depends on what you want.”
We have the style of healthcare we evidently want. It attends almost exclusively to the physical body, paying little attention to the experience of the sick person. Is that what we still want?
That question is especially pertinent during this pandemic. We’re medically quite limited, lacking cure, adequate testing, and effective immunization. We’re affected in significant non-medical ways, too.
Sick — and dying — patients are necessarily separated from loved ones. We suffer widespread anxiety and unfounded rumors. Our lives are utterly deranged, and we don’t know if or when they’ll be restored. But if, as they say, crisis’ flip side is opportunity, there’s much we can do in addition to physical medicine.
It depends on what we want. If all we want is to watch COVID-19 eventually head over the horizon, fine. But if we also want relief from suffering right now in the form of compassion, personal attention, counseling, and support, we can have that, too. Certainly many healthcare workers already act this way, but how can we steer the entire institution in that direction?
The Icahn School of Medicine at Mt. Sinai Hospital in New York City runs a program intended to give its graduates a head start in these softer skills. It admits scientific pre-meds, but also students who major in fields like English, anthropology and history. The assumption is that these students, having had more exposure than science majors to the human condition, will see their patients as more than medical problems.
They’re selected after their sophomore college year, and don’t need to take the notorious MCAT admission test.
This strategy has actually been around awhile. My own alma mater, USC, experimented with it for a few years in the 1960s, and I was one of its beneficiaries. Definitely not a science nerd, I was pretty good at languages, so they admitted me, along with several other atypicals. Once there, we discovered we had missed little: undergraduate science classes were largely irrelevant to medical training unless one planned to be a researcher. The college biochemistry that had been opaque to me in flasks and beakers came easily when it was about live humans.
Other medical schools are currently trying innovative admission policies and curricula as well. Some of class time devoted to traditional subjects like acetyl-coA production and the nature of mitochondrial nucleic acid is now shifted to communication skills, which will hopefully attain the impressive quality level of medicine’s science.
“Healthcare reform,” then, isn’t just about who pays for what. Genuine reform means getting what you want.
Jeff Kane is a physician and writer in Nevada City.