Joseph Cramer, M.D.: Improving health care one week at a time
It is said, the object of religion is to “Make bad men good, and to make good men better.” Religions all over the world have the same mission and use some of the same tools to fulfill that end.
One way to make men and women better is to call them together on a regular basis to learn from each other and use the power of social connections to model goodness. The frequency of worship every seventh day is part of the Abrahamic tradition of congregation.
Every week, each faith has their particular day. The Tribe of Judah meets on our Saturday, their Shabbat. The people of Ishmael pray at the mosque on Friday. Christians choose for the most part Sunday.
So if we want to try and make people good beyond their normal moral behavior, perhaps as a minimum we should come together weekly to talk and socialize about improvement.
For example, if we want physicians to become better, maybe we should ask that they meet at least weekly. Healthcare may benefit from lessons gleaned from religion, making a bad doctor good and a good doctor better.
In days past, doctors would convene regularly in the hospital and the doc’s lounge and they intermingled as part of a collective stratum. There would be parties where all the docs affiliated with a community would attend. Or there would be the department meetings that were based on shared interest. The hospital and medical societies were the center of the medical world and their social circles.
Now, all of that connectivity is over. Gone are the required medical hospital staff meetings. Department meetings are ignored or eliminated all together. The slayer of physician gatherings, interestingly enough, is the national accrediting body of hospitals.
The Joint Commission several years ago ruled that physicians do not have to attend all these meetings. Meanwhile, hospitals propagate their own kinds of regulations, such as, if you don’t attend you have to pay a fine. The money will count as if you were there. It’s chump-change for most doctors.
But what if every practice and every doc would set aside a holy hour each week to meet and talk about how to migrate from bad to good to better? It would not be chatting about finances or billing practices, instead the subject each week would be to improve. They could gather in a safe environment to share mistakes and, like repentance, they would learn the lessons to move from good to better by humility and truth.
The current problem with the culture of medicine is that too often autonomy puts quality at risk. To be captains of the medical ship means the whole craft and all the crew must be guided by a continuous commitment to become better.
Corporate and professional cultures are built first on assumptions; values follow from there and culture emerges. If the assumption is that the isolated doctors know best, the value that follows is physician infallibility. The emerging culture ignores human limitations and individual blind spots that add to errors. The reality is, one person alone cannot do it all.
The other power of weekly gatherings is that the body of knowledge of medicine exceeds the capacity of a roomful of doctors, let alone one or two. Learning what others know reduces the randomness that befalls docs when there is so much to comprehend.
It is also not just the written information that is critical for good and better to exist. Emotional support is equally important because it is scary to be responsible for a human life. Physicians have always learned at the side of another. Sometimes to improve it helps to have a friend nearby.
The journey of medicine from bad to good to better doctors demands that we refresh and learn from fellow clinicians. Let’s pray that healing can improve by the weekly squeezing of all the docs into the same pew. Amen
Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for 30 years, and an adjunct professor of pediatrics at the University of Utah. He can be reached at email@example.com.
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