Building a We out of a “To Me” Nation
Last week I wrote on the idea of connection. How has the way in which we connect to one another, not only as people in society but as patients and physicians, changed? And how has it affected the patient/physician relationship?
I received two fantastic comments from Ian Welsh that I didn’t want to respond to in the comments because it’s worth bringing the discussion out into the open, and because he pointed out something I’d planned on discussing this week (prescient!): the structure of the work done by physicians and the systems we design in which we do those work - both the larger systems and the smaller, including EHRs.
But Welsh points out a few other things that I want to respond to first, beginning this week with this:
I will also say that as a group, Americans (and Westerners in general,but Americans are leading this charge, as with many others) we have become a nasty, self-centered people. The constant fear we live in, of losing everything, which most people cannot acknowledge but which they feel, has eroded social trust. Likewise so many people make their living doing, well, bad things. If you work in the health insurance industry, your job is to extract from the health care system money which in a system which was working properly, would be used to care for patients, for example.
This is an interesting point. It’s a difficult one for me to discuss because I’m pulled in two directions. The sociologist and researcher in me wants to say “have we? That’s (you know what’s coming) an empirical question. And one very much worth asking, if it hasn’t already been asked.” The writer in me wants to say yes, we have. The writer in me then sends the researcher off to do a quick search and right off the bat, a study or two by psychologists on increasing levels of narcissism. Of course, psychology looks more at the individual level and we’re talking at the group level - which is more sociological - but both these look at trends across groups, and I’m still looking. Let me know if you have any studies. But I feel more comfortable saying this now:
Yes. We’ve become increasingly self-centered. We are fearful.
One of the things we seem more and more afraid of is not being an individual. Of not being special. Of not having a special place somewhere, anywhere, everywhere. I jokingly refer to this as special snowflake syndrome, but it can of course be very ugly: If I think you are more special than I am, it scares me. I don’t like that about you. I don’t trust you. I will tear you down in order to build myself up. We’re all familiar how the internet feeds this, with its windows into the Very Happy Experiences and Perfect Lives of Others.
Some time ago, I began to observe this around me, in my life and in others, particularly with women. It bothered me, so I took pains to see if, on a small and personal level, I could correct it. Sometimes I’ve been successful: I’m better at telling women I admire them, or learning from people who are better at doing things or being a certain way than I am. Sometimes I’ve not been successful, and yes, it’s a nasty experience for everyone involved. But when it works, it is amazing the trust it engenders in others: It goes back to the connection I discussed last week, but it also touches on this idea of fear. What do you lose if you stop being afraid that you’re not so special? Or that your specialness doesn’t rest on being a perfect individual catered to by the universe at every single moment? You lose a lot of bad stuff, actually.
On a less personal - and less self-helpish (sorry) - level, I think this is partly how we begin to rebuild systems Welsh talks about in the rest of his comment. Systems that no longer exist, in which people who go out of their way to help others are not outliers, are not punished for caring in systems that reward mediocrity. We simultaneously need to be willing to be people whose first instinct is to care for others and accept that the universe is not putting us first at all times, and perhaps not ever. We have to stop being “TO ME” Nation.
When you walk into the doctor’s office, for example, and you get pissed off that the doctor has only 15 minutes to see you and is 45 minutes late, what do you do? I’m not talking about a particularly rude doctor or one who doesn’t give you the right information. I’m talking about very specifics. Do you spend part of that allotted 15 minutes complaining about the wait and then demand the doctor spend longer than your scheduled time discussing other problems, because you are important? Tiny insight into how the system works: Doctors have to see a specific number of patients every day in order to cover costs, such as malpractice insurance. They are reimbursed for particular types of visits in particular ways by insurance companies, and they can get around that but it depends on the doctor and whether they get around it in the patient’s favor or in their own favor. They don’t see you for 15 minutes because they just decided to be “efficient.” Sometimes they’re running 45 minutes late because the office is poorly run, sometimes because of another patient’s emergency, sometimes because other patients were late and then each of them wanted or needed the doctor to spend more time in the exam, or sometimes they themselves have a hard time staying focused.. Having observed physicians, it’s a rare one who can quickly and skillfully extract him or herself from a patient visit without making the patient feel slighted or like they got less than.
My point here is that it’s more than the connection I discussed last week. And yes, like I’ve brought up, being a patient in today’s healthcare system can be awful. I know. And there are plenty of self-centered, “to me” doctors. I’m not letting them off the hook. But we’ve build a system that sets us up for these failures, and we keep pushing it along. In these everyday healthcare settings, the “to me” moment arises, and we let it shine through. I’ve done it. We all have. We don’t think about it. Rather than say “hey, what a crap system,” we look at the individuals. We think “I’m paying for this, whether through a deductible or a co-pay or my ridiculous insurance premiums or what. I’m the patient. I’m the consumer. Me. Focus on me and my needs. Plus, I don’t want to wait. Plus, I just had to take off the afternoon from work and now you’ve inconvenienced me.”
Welsh jokingly (or not-so-jokingly) said, in reference to my last post, that “Be excellent to each other is a fine prescription, but it starts at the top, when we design the systems which run our society.” But I’m not joking when I say we can look at it as a 60/40 divide. Caring for yourself is necessary. As someone who has been a caretaker: Yes, you have to take care of yourself and be aware of your needs. You have to put your mask on first if the pressure drops in the cabin so you can help those who can’t help themselves. But put in 60, take 40. Take the focus off “me” for a minute. We are a society. Not a group of individuals.
Although here’s where I disagree - or if not disagree, then ask for a minor refinement. We can start at the bottom too, because we’re going to have to be the ones to design those systems. We have to want it. If we stay on the path we’re on, behaving the way we do, then who’s going to design it for us? Why would they? We stand up to fight for them and then focus on the fight through our individual lenses. If we are going to write this new social contract, if we are going to build these new systems that allow doctors to once again spend more than 15 minutes with you and to help you focus on preventative care, systems that are better than health insurance, which pulls money out rather than pours it back in, and systems that enable doctors like the one Welsh mentions in his comment, who sacrifices for his patients (and there are more of those than you think), rather than system designed to keep him from doing exactly that, then we - WE - have to be a we. Not just “to me.”
