Andrew Coates: For The Health Of Each And All

Sep 6, 2013

We physicians earn a place in society that yields great scientific and human insight, the impact of illness upon individual lives. Yet we are encouraged by forces inside and outside our profession to look away from the big picture.

Over the last year I have been struck by the force and magnitude -- and the health consequences -- of the pressures upon working people to make ends meet.

A great deal has been made about how rich the wealthy have become. 

Less attention has been paid to fact that the poor in America have gotten poorer, in their tens of millions. Consider for instance that in New York state 52% of seniors live at the edge of poverty or that those living in poverty has grown, not diminished, since 1980 and in New York households in the bottom 20% of earnings have seen no gain in income for two decades.

Day to day the strain of impoverishment, even as the official culture celebrates opulence and waste, creates conditions for the ravages of drug and alcohol abuse and addiction, for domestic violence, child abuse and neglect, as the repercussions of mass incarceration and the stress and strain of temporary and part-time employment weigh down upon us all.

I could insert here several shocking stories of patients I have cared for, often in the intensive care unit. The patients I have in mind suffered illnesses potentially catastrophic but completely avoidable -- if only the social or family circumstances been but slightly different. I know my colleagues in other specialties see avoidable illness, often the consequences of untreated chronic illness and disastrous delays in obtaining care.

Although we all have grown accustomed, after decades of loud mainstream pronouncements, to the idea that a dog-eat-dog, every-man- for-himself ethos always leads to the best and fairest outcome, we caregivers know how silly these notions really are. Human beings do not deserve, let alone seek, their illnesses.

Could we really believe that some of us live lives not in pursuit of happiness, but seeking misery? At the end of the day we are all in this together. If the purpose of a democratic society is to support the chance for each individual to realize our potential, then an injury to one is truly an injury to all.

We doctors can tell you about the injuries. About the social conditions that create them, we don't often have much to say.

The daily practice of medicine over recent decades has taken us farther away from the profession's tradition of advocating for the health of everyone in our society. Over recent decades the practice of medicine has been steadily besieged by commercialization and corporatization.

In response we physicians often struggle to remain focused narrowly upon the clinical question at hand. This can further separate the patient's medical problem from its human context.

Clinging to our expertise one patient at a time has acquired its own urgency and momentum thanks to a blizzard of perverse financial incentives that undermine science, and a progressive intrusion of assembly-line management techniques that undermine caregiving. As a result, although we may see a big picture, we too often feel powerless to act upon our scientific and human understanding.

It is time we took a stand as a profession and as professionals that we care about the health of the entire society. That the conditions for health and personal development for each of us depend upon a society that cares for all us.

Dr. Andrew Coates practices internal medicine in upstate New York. He is President of Physicians for a National Health Program.

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