Zen and the Art of Healthcare Improvement

I remember near the end of the book Zen and the Art of Motorcycle Maintenance (apologies if I get some of the details wrong; I read it a long, long, time ago), there's this scene where the narrator's son, who has been riding along with him on this voyage across America on the back of the motorcycle, stands up in his seat and looks out over his father's head.

"Wow, you can really see a lot from here," he said.

As it turns out, while the father had been having this transformative, life-changing view of the world, the road rolling out in front of him, new horizons opening up, his son was staring at the back of his jacket as the motorcycle transported them both down the same highway. A mind-expanding voyage for one, an endless unchanging obstructed view with occasional flashes of fleeting newness going by on the sides for the other.

As I reflect back on a lot of these columns I've written, I've been struck that a lot of them have been inspired by things that make me or my partners in our practice go crazy, things that happened during the care that we provide for our patients that just defy all logic. What seems to be missing, perhaps, is the point of view of the many others who are involved in the provision of healthcare today.

Whenever I look at social media, when somebody there talks about a healthcare experience -- what it was like when they ended up in the emergency room as a patient themselves, or had to deal with a huge surprise medical bill, or helped a loved one go through an end-of-life experience -- I'm often struck that in the comments there are always multiple disparate opinions offered up. There were others who had completely different experiences, or who saw these things in a totally different way.

Just the other day I was walking home from work and talking to a new acquaintance of mine, a subspecialist in another field in medicine, and when I told them what I wrote about, they said, "Boy, do I have a lot of stories I could tell you that you could use in your column."

I know when I see the comments that pop up on my own columns, I'm often struck by how I've missed something, how I've failed to see the whole picture, how it looks totally different to someone coming from another perspective. I can only speak to what I experience, and what others tell me they've encountered, the pitfalls and barriers to them providing the best care possible for their patients.

I have always hoped that this column would foster more discussions that can lead to improvements in the systems of care we have, to push for meaningful change inspired by those on the front lines of healthcare, and take into account the points of view of all the other people who are needed to get and keep our patients healthy.

This must include the entire workforce at our practice -- every member of the team. It needs to include the patients themselves, their family members, and their social support networks. We must hear from those that create the policies at insurance companies we rail against, the executives of the pharmaceutical industry, and those who draft the laws that govern healthcare in this country. It's the nurses, it's the pharmacists, it's the hospital CEOs, and it's the drivers of the ambulettes that bring the patients in to see us.

My point of view is only one point of view, but I hope that it's one that helps foster conversations, makes us mad, makes us want to demand change, makes us want to be unwilling to accept the status quo. The whole point is to root out the injustices and inequities, to create a place where everyone has access to all the care they need, right when they need it.

We want to push for a day when no one in this country will ever suffer for lack of care, and no one will ever go bankrupt to receive the care they need. That no one will ever need to choose between rent and health, between food and medicine, and between physical health and mental health.

We have a long way to go, and the view from the front of the motorcycle shows there's a lot of potential out there, a lot of opportunity to make things better, to make things right. Now we all need to do is just stand up from our perch on the back of the motorcycle and take a look around.

And see what we can see.

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