Although I come from a family of artists, I have little artistic talent. As I grew up, I found myself drawn to areas of expertise that I considered technical–in which there was a clear right and wrong. I guess I was a rebel. In high school, I became increasingly interested in medicine: I saw it as a wonderfully tangible application of scientific knowledge, a means of reducing human suffering. I set out to see what working in healthcare might be like. I found work in a private practice as an after-school job and spent a summer interning in a primary care medical clinic at San Francisco General.
In both of these experiences, I noticed the impact of non-scientific factors on the delivery of care. For example, at the private practice, the economic forces were clear: only patients with private insurance were accepted and I was instructed to book two patients per seven minutes. At the medical clinic, I learned of how treatment options and referrals are influenced as a consequence of the tangled private-public health care system. I saw the difficulties of translating the science: from an individual patients’ ability to follow his or her prescription regimen and health advice to having access to safe and effective medicines to begin with. I began to realize that medicine was not simply the application of scientific knowledge.
As a premedical student, I felt compelled to study how social, political, and economic factors impact medicine, but this didn’t fit into any pre-defined major, so I designed my own program of study. I used medical/bioethics to shape and direct my studies and included fieldwork in order to learn, by practical experience, aspects of the rapidly evolving health care industry. I worked for a physician-owned health insurance company, for a bioethics think tank and research group, and for a startup ranking pharmaceutical companies on their bioethics and social responsibility performance. My area of focus became a resounding Market Motives in Healthcare.
I wanted to change the system; I was fired up.
Then I started medical school. As an undergraduate ethics major from a family of artists, I had the minimal experience in the sciences to gain acceptance to school, and it was a colossal transition. All of my efforts went to learning human pathophysiology, biochemistry, the physical exam, and on and on. As a resident, I joined the Hospital Ethics Committee, but continued to focus on learning psychiatry, and didn’t feel like I had the capacity to take on too much else. I saw the problems all around me, I thought about them every day, but they started to seem so extensive, so embedded, so completely out of control, that I developed a sense that I could not ever possibly be a part of any sort of meaningful change. I directed my energy inward, making sure I learned what I needed to learn to provide the best possible and safest care to all of my current and future patients. But something felt like it was missing, and I could not shake the sense that I was not doing enough and that I wanted to do more.
When I found out about the Academy for Emerging Leaders in Patient Safety, I felt a spark re-light. My hope for this week is that I can re-engage with the work of improving how we deliver care to our patients on a systemic level. I look forward to making connections, learning from others, and beginning to see how I can make patient safety an integral part of my duty as a physician. Thank you for this opportunity.
