The Necrotic Center of Healthcare: the Physician Culture
The moment that crystallized my journey towards the outside of a hospital’s four walls came during the first half of my medical intern year in downtown Manhattan. The chair of our internal medicine department was giving a lecture on heart disease–and reminding us it was still the #1 killer in the United States, and that poor diet and sedentary behavior were major contributing factors. This was while we were being served greasy pepperoni pizza and sugary soda, and being forced to sit through four hours of lecture straight with no breaks. The irony was too thick…
It occurred to me in this setting during the fall of 2006, that the change I hoped to see towards prevention and lifestyle medicine wasn’t going to happen from within the traditional healthcare system anytime soon… and that I didn’t wish to follow the evident hypocrisy I witnessed in the physician culture and lifestyle.
I had always given myself a 5-10% chance of practicing medicine after my intern year. My parents, both physicians, and older sister, also a doctor, and many other family members, friends and colleagues all encouraged it. As did the faculty and upper-level residents at my program. I entered my intern year with the clear intention of going into business and starting a company–I even wrote it on my personal statement. Yet, I always gave room for practicing, because I was physically immersed in the training and the opportunity was near. I was ready and open to be allured into the field.
But the price was too high–I couldn’t imagine prescribing endless blood pressure and cholesterol medications, knowing that patients and physicians alike were ignoring the root causes. How can I tell these patients to exercise and eat right, if I’m not able or willing to do so myself? I only saw one other hospital staff member at the gym, literally two blocks from the hospital, during my entire year of internship. The go-to staples during ER shifts were Two Boots Pizza and a UK-inspired fried fish joint. During overnighters, we were ordering double-burgers and cheese fries from a local 24-hour diner.
And I knew the irony wasn’t unique to this specific medical center in Manhattan. Classmates shared similar experiences at their respective programs across the country. In Houston, our county hospital only had a McDonald’s available past 8 or 9PM. There was also a McDonald’s on the main floor of one of the most prestigious private hospitals in the area–it was like we were priming our own patients for boomerang caths…
I was craving the ability to embody what I had learned–to exercise, eat right, sleep well. But ironically, what was blocking me from pursuing those daily goals, was my commitment to the field espousing them… the physician culture itself.