Love You Into Being

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A couple of weeks ago I met my new medical students.  These 10-12 trainees will be my small group for the next two years.  We will meet monthly to discuss the soft stuff of medical training—hierarchy, tribalism, death and dying, medical errors, difficult patients, etc.  Some call it “third year medical student support group.”  This is my 6th year of the pleasure and privilege (I inherited my first group halfway through, when their previous preceptor moved out of state).

With each successive group I am ever more amazed at the students’ level of insight.  They articulate compassion, humility, and maturity that I don’t think I had at their level of training. Or maybe it’s because we did not have classes like this to explore such things when I came up (or maybe I don’t remember?).  More and I more I see my role as facilitator more than teacher.  I am not here to impart medical knowledge.  Rather, it is my job to stimulate exploration, conversation, and meaning.  It’s so freeing, really—there is no standardized test to teach to.  And yet I see it as my responsibility to help prepare these gifted young people to face the greatest challenge and reward of the profession: human relationships.

I feel no fear or trepidation.  We cannot ‘fail’ at this class, any of us.  Because the point of it is simply for everybody to participate, contribute, consider, and learn—myself included.  Each month the students are given questions to answer in the form of a blog post.  For example, “Recall an example of inspiring or regrettable behavior that you witnessed by a physician.  Describe the situation, and its impact on you, the team, and/or the patient.”  I read them all and facilitate discussion, tying together common themes and asking probing questions.  My primary objective is to help them maintain the thoughtfulness and humanity that led them to medicine in the first place.  Medical training has evolved in the past 20 years, for the better in some ways, not so much in others.  One way we do much better nowadays is recognizing the hidden curriculum, and shining light on its effects, both positive and negative, through classes like this.

We all have those teachers who made a difference in our lives—or at least I hope we all do.  I have multiple: Mrs. Cobb, 4th grade; Mr. Alt, 7th grade math; Ms. Townsend (now Ms. Anna), 7th grade English; Ms. Sanborn, 7th grade social studies; Mrs. Stahlhut, 9th grade geometry; Mrs. Summers, 10th grade English; Coach Knafelc, varsity volleyball; Dr. Woodruff, primary care preceptor; Dr. Roach, intern clinic preceptor; Dr. Tynus, chief resident program director.  My mom is one of these teachers, also.  She leads nursing students in their clinical rotations.  I have seen her student feedback forms—they love her.  And it wasn’t until I heard her talk about her students that I realized why they love her and what makes her so effective—she loves them first.  Teaching is often compared to parenting.  Our parents, at their best, see our potential and love us into our best selves.  They cheer us, support us, redirect us, and admonish us.  They show us the potential rewards of our highest aspirations.  If we’re lucky, they role model their best selves for us to emulate.

All of my best teachers did (do) this for me.  I’m friends with many of them to this day, and I still learn from them in almost every encounter.  I love them because I feel loved by them.  They held space for my ignorance and imperfections.  I always knew that they knew that my best self was more than the last paper I wrote, the last test I aced, or the last patient encounter I botched.  To them, my peers and I were not simply students.  We were fellow humans on a journey of mutual discovery, and they were simply a little farther along on the path.

This is my aspiration as a teacher, to live up to the example of all those who loved me into the best version of myself today.  This kind of love allows for growth and evolution, from student to colleague, to friend, and fellow educator.  This is not something attending physicians typically express to medical students, positive evolution of medical education notwithstanding.  But when I met this new group, I was overcome by love for them.  So I told them.  “If you take away nothing else from our two years together, I want you to have felt loved by me.  I wish to love you into the best doctors you can be.  That is my only job here.”  Or something like that.  It was impulsive and possibly high risk.  But it was the most honest thing I could say in that moment, my most authentic expression of my highest goal for my time with them.  I only get to see them once a month, and I want them to be crystal clear about what I am here to do.  We have lots to cover these two years, so much to learn and apply.  And love is the best thing I can offer to hold us all up through it.

Innocence, Indignation, and Idealism:  An Optimist’s Reconciliation

I took my daughter to see “Wonder Woman” last weekend.  I highly recommend it—such a strong, complex, and inspiring portrayal of humanity at its best and worst, with a hopeful ending.

Today I’m (somewhat) inspired in parallel by (some) politicians, three Republican senators in particular, calling for transparency in drafting healthcare reform.  I hereby present my attempt to integrate that exquisite Wonder Woman Experience with my current political outlook.

***WARNING*** THIS POST MAY CONTAIN SPOILERS FOR THOSE WHO HAVE NOT SEEN THE MOVIE.

Innocence

Diana of Themyscira grows up believing in the innate goodness of humans.  The Amazons are educated, independent, strong, and proud, and also collaborative, compassionate, kind, and sensitive.  When Diana learns of the horrific war waged by mankind outside of her paradise home, she relates it to the story of Ares, the God of War, who corrupts the hearts of men to commit acts of hatred upon one another.  So, naturally, she sets out to kill Ares and fix it.

We journey with Diana through challenge and triumph, as she learns that, of course, it’s not that simple.  She kills the man she thought was Ares, and nothing changes, the war rages on.  She must reconcile the possibility that the heart of mankind is not actually pure goodness.  Even without an insidiously corrupting God of War, humans are prone to their own malignant beliefs and actions.  Her innocence is pierced.

In the summer of 2009 or 2010, my best friend from college and his wife came to visit.  He, a molecular biology and political science double major and emergency medicine physician, and she, a worldly intellectual and future legal counsel for a major media outlet, were the first to burst my innocent political bubble.  For some reason, likely due to the tremendous inspiration of Barack Obama, I had gone from thinking all politicians were liars and performance artists, to seeing them as genuine public servants, working to advance their authentic ideas of how society functions better for all citizens.  I know, La-La Land!  My friends described an alternative, more realistic path to politics: Person succeeds at business, rubs elbows with regulators and influences them (with money or otherwise) to facilitate his/her business success.  Said person then realizes s/he could actually become one of those regulators and make a more permanent positive impact on these business interests, and so runs for office.  I still remember how deflated I felt, shoulders slumped, spine rounded, at this sudden and stark realization.

Indignation

As with everything, I’m sure political reality lies somewhere in the messy middle between pure altruism and blatant, self-serving avarice.  But these days, for someone who loved Obama and almost everything he stood for, it’s hard not to see the whole of our current political landscape as the latter.  I think, Really, WTF?  Can those in power really see nothing valid whatsoever in anything accomplished the past 8 years?  Do they really think that see-saw policy-making, each administration reversing everything from the previous one, replacing wise, experienced public servants with ignorant neophytes (my opinion), is the best way to govern?  OMFG, you have got to be kidding me.  I seethe.  But what can I do?

Ares reveals himself, and taunts Diana in her most vulnerable moment with his arrogant disdain for man’s weakness and corruptibility.  He also reveals that she is, in fact, the only one who can vanquish him—only a god can kill another god.  Diana, daughter of Zeus himself, possesses the power to Kick. His. Ass.  Yet he dismisses her out of hand, oblivious to her inner strength of conviction and compassion (I know, so much to expound on here, maybe in another post!).  Nope.  Righteous indignation rises.  She digs deep, finds that core courage, and obliterates him.  Fist pump.  He never saw it coming.

Idealism

In the end, Diana realizes that humans are a paradox: a big jumble of contradictions, perpetrators of horrific rage and destruction, and also fully worthy of love, forgiveness, and compassion.  She somehow finds peace in this enigma, loving the best of humanity and vowing to protect us against our worst selves, helping us to become better.

This resonates with the idealist in me.  This is how she helps us, and how we can help ourselves.

How Can We Help?

We can choose to fight against one another, and thereby focus on what we hate (about ourselves).

Or, we can choose to seek the good in one another, and focus on what we love— even better, focus on love itself.  We all want access to healthcare, and to be free from bankrupting medical expenses.  Everybody wants to be safe from gun violence.  We all want an efficient government that sets reasonable regulations, protects citizens’ constitutional rights, and spends money wisely and with accountability.  We all want to feel protected and free, loved and free to love.

The messy middle is the how.  That is where we negotiate.  That is also where the magic happens, as Brené Brown says, and that is where we must go, where we must persist.  We can bring our best selves to meet others’ best, in mutual respect.  It can be high risk, so we can enter slowly, strategically, with realistic expectations and a few trusted friends.

To this end, I will continue to seek out and hold up elected officials who call for more thoughtful political processes.  My friend Triffany and I have made a habit of writing thank you notes to Members of Congress to validate their cooperative acts.  We harbor no illusions about purity of intent, but we also know that positive reinforcement works.  We can be Diana to anybody’s Ares.

Focus on and fight for what we love: common goals and interests, shared humanity, connection, and one another.  It’s a lifetime’s worth of work, and well worth the fruits, if we can stick with it.

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Everyday Power and Influence

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If you wonder how physicians think and feel, about anything and everything related to medicine, healthcare, economics, parenting, relationships, and life in general, check out KevinMD, an expertly curated blog by physicians all around the world.  I recently read a heartening and important piece on gender equality in medicine.  A pediatrician husband wrote about the stark differences in assumptions about work-life balance for men and women, in “What Does Your Husband Think of You Being a Surgeon?”  Then I came across another article by a male cardiologist, whose wife is also a physician, entitled, “The Gender Gap in Cardiology Is Embarrassing.”  Both men’s wives delayed their medical training, and these husbands bore witness to our culture’s implicit gender bias against their life partners.  I strongly encourage you to read both pieces; they are short and poignant.

—- Please click on the links and at least skim the articles, before continuing here. —-

Now, consider how much more weight and influence these pieces carry, simply because they are written by men.  If you find this difficult, imagine your internal response if they had been written from the women’s perspectives.  Which position is more likely to evoke, “Hmm, interesting,” as opposed to, “What are these women whining about?”

When we consider advocacy, it’s fair think of it as those with more power and influence using these advantages to champion those who have less.  Sure, the less powerful and influential can and do advocate for themselves, but without allies among the advantaged, the message and movement stall and stutter.  Consider slavery and the Civil Rights Movement.  If it were only ever black people advocating for themselves, what would the American racial landscape would look like today?  Think about women’s rights.  There is a reason the United Nations launched the HeforShe campaign.  Self-advocacy is required, but sorely inadequate, to lift people out of oppression.  And let’s be clear: oppression takes many forms, which we often fail recognize or acknowledge.

I have a fantasy about patients advocating for physicians.

I imagine Sally and John*, two friends communing at their favorite coffee shop, one of their regular meetings of mind and soul.  The conversation veers toward healthcare, and Sally starts ranting about how physicians don’t care about patients anymore.  They’re only in it for the money, having sold out to pharma and industry, and they think of themselves as second only to God him(her)self, exercising control over patients’ lives with little regard or actual caring.  In this coffee shop scenario, I as physician have no power or influence.  If I sat there with them, trying to explain how ‘the system’ drives wedges between us doctors and our patients, about how on average doctors spend twice as much time on administrative activities as patient care activities, how 50% of us report burnout, and how our suicide rate is up to 4 times that of the general public, I estimate that I’d likely be seen as whining and making excuses.  In this scenario, facing a (rightfully) prejudiced audience, my voice counts for very little.

Although physicians still enjoy a fair amount of respect and deference in society, our struggles, personal and professional, are still poorly understood by the general public.  I think people are even less cognizant of the insidious and profound detriment that physician burnout and depression have on patient care and the economy at large.  But when doctors describe our adversities to patients, I think we still come across as whining.  Knowing that I write this as a physician, what is your reaction?  Is it closer to, “You live at the top of the food chain, what are you complaining about?” Or rather, “Wow, what’s going on that so many doctors feel so badly, and how could we all help one another?”

Lucky for doctors everywhere, John is my patient and we have a longstanding, collaborative relationship.  He empathizes with Sally’s perspective, as he knows what she has been through medically.  He has also inquired about my work, and understands the systemic frustrations that physicians face in all fields.  Because they are such good friends, John feels comfortable challenging Sally’s skewed assertions.  He describes what he has learned from me, and explains earnestly that all doctors are not, in fact, swine.  Because he is her trusted confidant, she believes him.  Her attitude opens ever so slightly, and she is more likely to acknowledge how physicians and patients alike suffer from our overall healthcare structure.  John is, in this case, the strongest advocate for me and my ilk.

Whenever one of us stands up as a member of a group, and speaks up to our peers on behalf of another group—white people for black people, men for women, Christians, Jews, and Muslims for Muslims, Christians, and Jews, liberals for conservatives, physicians for patients, and vice versa in each case—we are all elevated.  Our mutual compassion and humanity are called forth to heal our divisions.  This is how personal advocacy, how everyday power and influence, works.

As a patient, you have more power than you may realize.  I bet most people don’t necessarily feel adversarial toward doctors.  But they probably don’t necessarily feel allied, either.  What can you, as a patient, do to bridge this gap?  How else could we all, physicians and patients alike, create that essentially healing inter-tribal connection?

*Hypothetical friends

Getting Past ‘You Suck’ as Dialogue

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Hello again friends, and Happy New Year!  It feels good to be back.  Diving right in with long form again…

This recent article from Wired got me thinking (again), there are so many layers and moving parts to healthcare reform, that no one player stands to lose all or benefit all from any changes.  And yet so much of what we read and hear has an, ‘it’s so simple, they just don’t care about you, but I do’ tone.  The piece describes why insurance companies, who may have advocated most fervently against implementing ACA regulations, actually have a stake in maintaining its current status.  Nothing in our healthcare system is black or white, all good or all bad.

So when I see politicians (and friends) speaking and writing in oversimplified sound bites, and vilifying a whole group (all liberals, all Republicans) over one aspect of their point of view, it really frustrates me. That is exactly the opposite of productive dialogue.  It just makes people stop listening, because they don’t feel heard or understood.  So they have no incentive to hear or understand you.

Many use the car insurance analogy to explain health insurance.  It’s not exactly parallel, but it makes some sense.  The law requires every car to be insured.  (Drivers of) cars that don’t violate traffic law get lower premiums, the longer they stay ‘safe.’  The more traffic law violations, the higher the risk, the higher the premium.  I have an actuary friend, who works for a health insurance company, who advocates, in part, for higher premiums for those who ‘use’ the healthcare system more—like the higher risk cars (drivers).  I understand this logic.  But this idea of making older and sicker people, and women pay more, just because they ‘use’ the system more (and thus financially speaking cost more), does not sit well with me.  People are not cars.  Not everybody maintains their cars well.  But poorly maintained cars do not necessarily lead to increased accidents and traffic law violations.  Poorly maintained health often leads to a human body’s multi-car highway pile-up equivalents.

My friend advocates for insurance coverage for catastrophic care (also aligned with the car insurance model), but not necessarily for preventive or primary care.  There are different ways of ‘using’ the system. If you get preventive care, like recommended cancer screening and annual exams, it may cost more at the time. If you seek help for your back pain early, from your PCP, chiropractor, and physical therapy, that costs money.  But if these early interventions prevent future, more catastrophic and costly outcomes, should we really penalize those who make them?  Illness and infirmity come with age.  So, often, do fixed incomes.  Is it right to make our elderly pay more for their care?

There are costs and benefits to care other than money, which is where health insurance and car insurance diverge sharply, in my view.  I know they are harder to quantify and assign, but they matter.  That secure feeling that I can get care when/if I need it, that my children and I have access to professionals dedicated to my health and well-being, a sense that in our society, I matter just as much as the next person, regardless of my net worth—these things all matter.  Each individual’s health or illness contributes synergistically to the health or illness of a society.  A mother’s depression, untreated and uncontrolled because her health plan does not cover mental health services, can negatively affect every aspect of her and her children’s lives, emotionally, physically, financially, and socially.  We cannot only look at healthcare on dollar spreadsheets of ‘use.’

Maybe it’s about priorities and philosophy—ideology?  Do we feel all people have an equal right to equal care, or do we differentiate what people deserve based on particular group memberships or other characteristics?  Do we feel we should only be responsible for ourselves, or are we called to look out for one another?  I personally believe in equal access to care and ‘look out for others as yourself.’

I also believe that people need to understand–personally and concretely–that everything does cost money, we all pay for one another’s use (and disuse, and misuse) eventually, and more care is not necessarily better.  So I understand and partially agree with my friend’s argument that people need to have ‘skin in the game’ to control overuse of services for no benefit.  One great example is end of life care.  I like this article from Fobres, which describes the conundrum succinctly:

According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life.  I know there are other studies out there that say slightly different things, but the reality is simple: we spend an incredible amount of money on that last year and month.

Dr. Susan Dale Block, Chair and Director of Psychosocial Oncology and Palliative Care at the Dana Farber Cancer Institute and Brigham and Women’s Health Care, recently shared some data with her colleagues.  In the Archives of Internal Medicine, a study asked if a better quality of death takes place when per capital cost rise.  In lay terms … the study found that the less money spent in this time period, the better the death experience is for the patient.

 
Cost, longevity, quality of life, quality of care, value, perceptions, public health—these and other aspects of health and medicine are all inextricably enmeshed, though definitely not integrated.  Any decisions about one must be made in the context of all the others, carefully, transparently, and honestly.  Whenever we hear, ‘if we just do this, everything will be better,’ red flags should fly.

I wrote the first draft of the paragraphs above on my Facebook page.  I ended the post with, “So let’s each educate ourselves on the facts, as well as we can, and try to look at the big picture. It’s so messy.  And it’s what we’ve got, so let’s deal with it–with maturity, patience, professionalism, and equanimity.”

Another friend, a fellow liberal, commented, “This has nothing to do with healthcare. It’s about reducing taxes on the wealthy, reducing benefits for the poor, and denying the democrats credit for anything good. If they actually cared about healthcare, they would fix the obvious problems with the ACA. And because the ACA was the republican plan, they will continue to tie themselves up into pretzels to disown it and put something else in place. That being said, I hope the American people continue to demand access to affordable healthcare for all. It’s a right, not a privilege.”

I had to reply: “(My friend,) I understand your point of view, and I share your passion for equality.  But your statement exemplifies exactly the broad brush, ‘you suck’ attitude that I see holding us all back.  I refuse to believe that all Republicans are only motivated by making the rich richer, and that none of them care anything about the poor, as so many of us on the left say.  We must extricate ourselves from this destructive narrative and learn to hold space for everybody’s complex views and experiences.”

My point here is that nothing is as simple as we’d like.  It’s so much easier to blame those who disagree with us for being stubborn, selfish, or evil, than to cope with the discomfort that our system is deeply flawed, there are no easy answers, and our fundamental philosophical differences make it that much harder to agree on the best way forward.  And yet, this is what we are called to do.  It’s up to each and every one of us to change our language.  Each of us has, I believe, the opportunity and the responsibility to create an environment in which open, respectful discussion and debate are the norm, rather than echo chambers and verbal warring.

I am only one person.  I have no designated leadership titles or widely visible platform.  But my words have power.  So do yours.  Please use them wisely.

 

On Community

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NaBloPoMo 2016, Letters to Patients, Day 10

To Patients Who Feel Alone Sometimes:

Who holds you up?

Day 2 post-election, it is still positively surreal.  Monday night I saw Facebook friends post passionate, emotional, sometimes desperate pleas, urging their friends to vote one way or another.  I also saw friends acknowledging the long, strange trip, looking forward to the next chapter, expressing both relief and trepidation.  A cloud of separation hung over my heart as I read some of my friends’ words then. 

Something inside urged me to contact a high school classmate.  We did not know each other well back then, and we didn’t always like each other.  But I always felt a mutual respect.  She does not post about politics; I do…a lot.  I know we differ in many of our positions and views.  I also know her to be thoughtful, kind, ethical, and just.  I know she has a lot going on in her life right now.  Our Facebook friendship has grown the past few years, and more and more I feel a cosmic connection.  I am meant to know this person again and better, in this later phase of life.  So I messaged her privately, just to tell her I was thinking of her.  I sent hope, and wishes that we could sit down over tea, somewhere cozy, and share our lives—slowly, thoughtfully, kindly, lovingly.  Turns out my little message helped hold her up yesterday.  On this day of anxiety and tension, hope and uncertainty, this long-distance connection gives me strength and peace.  It reminds me of a recent article by the Dalai Lama on our need to be needed.

I’ve said and written so often that I’m so grateful for my tribe(s), the communities that surround and support me in everything I do.  When I see patients, I make it a point to ask about emotional support networks. They don’t have to be vast or deep.  They just need to be strong and reliable.  No matter what our station, our illness, our cultural origin, or our political leaning, we live longer, healthier, happier, and easier when we connect with others.  It can be many, often, and deep.  It can be few and intermittent.  It just has to be meaningful and enough.

Lastly, supportive relationships function best when they are also reciprocal.  I don’t mean quid pro quo.  I mean mutual, shared, communal, uncalculated support.  I ask patients, “Do you have enough people you know you can turn to, people who will be there for you, in times of personal crisis?”  I want so much for you to answer without hesitation, “Yes, definitely, no question.”  Then I can relax about your health.  You (all) got this.

On the Critical Importance of Self-Care

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NaBloPoMo 2016, Letters to Patients, Day 6

To Patients Who Feel Overwhelmed:

Put your own mask on first!

In my spare time, I go around talking to other doctors about how to take care of ourselves.  You may or may not be aware of physician burnout.  It’s quite the trendy topic in medical circles these days, and not in a good way.  Over 50% of physicians report at least one symptom of burnout (emotional exhaustion, depersonalization, or low sense of personal accomplishment), higher than the general population.  Physicians also kill themselves at much higher rates than the general population.  I’m grateful for the opportunity to study and speak on physician health and well-being, because it informs my practice in ways I had not anticipated.

To be clear, physician burnout is not a problem of personal weakness on the part of doctors themselves.  The healthcare system in the United States has evolved to such a dysfunctional state that some of its best and brightest find themselves despondent, depressed, and ready to quit.  And yet, we are called to persevere in the system as it is, even as we strive to improve it.

I see the same pattern in American society generally.  Technology and other advances have created a world of 24/7 hyper-stimulation, global comparisons of productivity and innovation, and immense pressures to be perfect, or at least appear so.  Men and women live under constant scrutiny and competition.  Do I make enough money?  Is my work impressive enough (to others)?  Are my children in the right activities?  Am I doing enough?  I see, hear, and feel it from my patients every day—the anxiety, the uncertainty, the angst.  The suffering is real, if not totally tangible.

For those of you whose exercise routines hold you up, how quickly do you abandon your workouts when things get really busy?  What about quality time with your friends?  What about your painting, knitting, writing, reading, skating, volleyball, music, and sleep?  Everybody recharges a different way, but I see a common pattern of ignoring the low battery alerts and pushing ourselves to empty—physicians and patients alike.

Our systems need to change, no doubt.  Medicine, business, education, politics…  We need to get clear about what and whom we really serve.  In medicine, I believe physicians should lead the movement toward a more humane internal culture.  There is no way we can take excellent care of our patients if we are not well ourselves, and we cannot wait for corporate leaders and policy makers to advocate for us.  The same is true for you, our patients.  What do you need to be healthy?  What can you change in your habits, environment, and relationships to meet these needs?  And in making such changes, what positive ripple effects could you have on those around you?  Can you lead by example?

If we all put our own masks on first, like they say on airplanes, how many other people’s masks could we help with?

Holding the Space for Expectations Challenged

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Those of you who follow this blog know that I meet regularly with a group of insightful and engaging medical students. I have written about them here and here. At our meeting last month, one of them described his recent rotation in China, and I invited him to share his experience here. I’m so grateful for this continued connection to physicians in training—it keeps me grounded. It reminds me that no matter how old and wise I may consider myself, I always have much to learn from others.

Enjoy, everybody:

 

Expectations. In the United States, we have come to have certain expectations for how things should be. A meal at burger joint should include a burger, with a side of fries and a Coke. When we check into a hotel, there should at least be a TV and a coffee maker with complimentary coffee. These have become essential (American) assumptions, and because we are the “best in the world,” our way is the best way.

Similarly, when you go see a doctor, there are certain expectations, both good and bad. You expect that it may take a few days to get an appointment. You expect a reminder prior to your appointment. You expect to wait a certain amount of time to see the doctor and to fill out a ton of paperwork. You expect the staff to be courteous. You expect to see a nurse first, and to wait again in an exam room until your doctor arrives. You expect the doctor will listen to all of your health problems closely, and offer helpful suggestions regarding imaging and medications you can take. You expect those prescriptions to be sent to your pharmacy, and that you can to pick them up after your appointment. You expect to get better.

What if your reality ended up very different from these expectations?

Last month, I went abroad to see what the healthcare system is like in China, at an academic teaching hospital in the nation’s capital of Beijing. After spending a year deeply entrenched in the clinical wards of the United States as a third-year medical student, learning from the best of the best doctors, I thought I knew what it meant to provide good medical care. I expected that I could teach them better ways of delivering care based on what I learned in America. I soon found out that I was the one who had a lot to learn.

To provide some perspective on just how different the healthcare system is in China, imagine this scenario, based on an amalgamation of different patient experiences that I witnessed:

You are sick and want to see a doctor. You wake up the next day at 5 in the morning so that you have enough time to take the subway to get to the hospital by 6. When you arrive, there are already 30 people in line ahead of you, and the specialist you want to see only gives out appointments for 25 people for his morning clinic today. You don’t end up getting an appointment.

You go into the doctor’s office when he arrives at 8, bursting in the door with 10 other people who are sick but were unable to get appointments. You fight for the doctor’s attention during his first patient’s appointment, and, luckily, you get an add-on appointment, for after his 25 other morning appointments. You sit in the waiting room until 12:30PM, when you are finally called in.

You see the doctor. He only has 5 minutes to spend with you. As he is doing your physical exam, his next patient enters the room before being called, and watches everything. The doctor says you need imaging, which you need to pay for and schedule yourself. You then need to pick up hard copies of the images and bring them to your next appointment, so that he can make a diagnosis. You also need some medical equipment, and he suggests shopping for it online. He says you may need to be hospitalized, but it may take 2 weeks to get a hospital bed spot, so you should sign up for the waiting list now. You get the imaging and medical equipment, the doctor makes a diagnosis, and you get better.

Your total cost for everything was less than $50.

Your gut reaction to this story may be, “this is madness!” You may feel that your expectations of healthcare delivery, based on your experiences in the United States, are very different from the care provided in China–not only different, but almost certainly better. At least, that was my gut reaction. I was appalled on my first day of clinic; my mind raced with questions: How do patients put up with this disregard for their time and rights to privacy and respect? How are doctors able to treat patients adequately without hearing the patients’ stories? Can patients have a good understanding of their medical condition in this system of care? It made me feel grateful for what we have in our current healthcare system back home, with better customer service, shorter wait times in the doctor’s office, and more privacy during the appointment.

However, take a second to reflect: is our healthcare system universally better? In this compiled scenario in China, you got seen by a specialist on the same day you got sick, which happens on a regular basis for patients familiar with how the hospital system works (even those unfamiliar with the system can still be seen within one or two days). Your overall costs were low and did not involve convoluted paperwork from third and fourth parties. And, most importantly, you were still able to get better. These are all things that hospitals in the United States hope to improve on. By the end of my first week in China, I realized that my gut reaction on the first day was irrational, stemming from discomfort with things I was not accustomed to. As I distanced myself from my premature judgment on what I was seeing, I found that the differences were not bad, just different. China has the challenge of providing healthcare to the largest patient population in the world, and with that, factors like cost containment and short visit times are prioritized. In the United States, we have also had to prioritize certain factors, specifically patient satisfaction, due to our cultural values and our legal system. In both countries, though, positive patient health outcomes are the highest priority.

Dr. Cheng asked me what three things I learned primarily from doing a clinical rotation abroad. First, different does not equal bad. While China and the United States do not have the same priorities for or access to healthcare, both have well-functioning healthcare systems. Second, withhold judgment from your expectations. Your gut reaction may not always be correct and may limit you from fully understanding things unfamiliar to you. Third, be grateful for what you have. Though our own healthcare system has its problems, we should be grateful for everything that works well, and we should not take it for granted.