You can't win on virtue
This is a story about pragmatism.
My med school has a professor, a neuroscientist, who for decades has worn himself down to the bone advocating for humanitarianism. He walks the talk, as the leader of a number of community outreach efforts. He's done a TED talk and testified before Congress. His standard of professional excellence is impeccable. Every time he lectures, he highlights the diseases, the injustices, the impacts that result from damage to the nerves we're studying. About one third of his lecture slides are marked "FYI" to indicate that we will not be tested on the material, and these slides list stat after stat on whom we are helping, whom we are hurting. Traumatic brain injury: who is going to take care of all these mangled soldiers and former teenage DUI quads when their parents are too old for the job? Geriatrics. Primary care. Nutrition. Palliative medicine. He rails against policies and against lack of policy. He rails against us for being willing participants in a profit driven medical system.
I love this man, truly, and I believe him, believe in him. But I get worn out. I don't have the goodness to take a moral working over like a vitamin with every meal. Mea culpa. My community work, excessive for a med student, is in organizations with which my most passionate professor is not involved. Mea maxima culpa.
Meanwhile, recently, a community physician from a major city visited EVMS and spoke about her work. She has an effective outreach model that trains low income HIV patients to visit other low income HIV patients, and support them in navigating their medical care and solving their ridiculously complex life problems. If ever there was an initiative with measurably positive outcomes that costs little and impacts the neediest, this is it.
I asked her to describe the effort to fund her organization. What happens when she goes after donors and grants? She described a heartbreaking, unending effort. Of course. But what she said that knocked the wind out of me is this: you can't win on virtue.
She can get a grant or a fellowship by showing effectiveness statistics. By filling out forms. By courting organizations that target populations segmented on zip code, religion, refugee status. By applying for funds that the ACA (that's Obamacare) allocated for ACOs (accountable care organizations). But if she tries to get funding by saying "this is the right thing to do" she gets nowhere. She can't win by saying "look at the humanity here." The Sally Struthers starving African child guilt-mercial model never broke even.
Clever gamesmanship. Marketing. Business savvy. Networking. Entrepreneurship. These don't naturally come to mind when I think about an operation that helps mentally ill homeless HIV patients get to their doctor appointments. It would be more comfortable to believe that those who have the backbone and dedication to serve the least of us don't have to have MBAs to get to do their work.
The genius of the visiting community physician, I think, is in her clever flexibility, her recognition of the need to fit her mission in a package of comfort for those who might provide funding. Hmm. Maybe the genius of my passionate professor is in his disregard for the comfort of med students. He makes it maximally difficult to confuse our ambition "to help people" with virtue.
My med school has a professor, a neuroscientist, who for decades has worn himself down to the bone advocating for humanitarianism. He walks the talk, as the leader of a number of community outreach efforts. He's done a TED talk and testified before Congress. His standard of professional excellence is impeccable. Every time he lectures, he highlights the diseases, the injustices, the impacts that result from damage to the nerves we're studying. About one third of his lecture slides are marked "FYI" to indicate that we will not be tested on the material, and these slides list stat after stat on whom we are helping, whom we are hurting. Traumatic brain injury: who is going to take care of all these mangled soldiers and former teenage DUI quads when their parents are too old for the job? Geriatrics. Primary care. Nutrition. Palliative medicine. He rails against policies and against lack of policy. He rails against us for being willing participants in a profit driven medical system.
I love this man, truly, and I believe him, believe in him. But I get worn out. I don't have the goodness to take a moral working over like a vitamin with every meal. Mea culpa. My community work, excessive for a med student, is in organizations with which my most passionate professor is not involved. Mea maxima culpa.
Meanwhile, recently, a community physician from a major city visited EVMS and spoke about her work. She has an effective outreach model that trains low income HIV patients to visit other low income HIV patients, and support them in navigating their medical care and solving their ridiculously complex life problems. If ever there was an initiative with measurably positive outcomes that costs little and impacts the neediest, this is it.
I asked her to describe the effort to fund her organization. What happens when she goes after donors and grants? She described a heartbreaking, unending effort. Of course. But what she said that knocked the wind out of me is this: you can't win on virtue.
She can get a grant or a fellowship by showing effectiveness statistics. By filling out forms. By courting organizations that target populations segmented on zip code, religion, refugee status. By applying for funds that the ACA (that's Obamacare) allocated for ACOs (accountable care organizations). But if she tries to get funding by saying "this is the right thing to do" she gets nowhere. She can't win by saying "look at the humanity here." The Sally Struthers starving African child guilt-mercial model never broke even.
Clever gamesmanship. Marketing. Business savvy. Networking. Entrepreneurship. These don't naturally come to mind when I think about an operation that helps mentally ill homeless HIV patients get to their doctor appointments. It would be more comfortable to believe that those who have the backbone and dedication to serve the least of us don't have to have MBAs to get to do their work.
The genius of the visiting community physician, I think, is in her clever flexibility, her recognition of the need to fit her mission in a package of comfort for those who might provide funding. Hmm. Maybe the genius of my passionate professor is in his disregard for the comfort of med students. He makes it maximally difficult to confuse our ambition "to help people" with virtue.
posted by Cy at 5:57 PM
4 Comments:
Amen sista! I remember first day of anatomy lab he laid into our table for considering future specialties based on quality of life, (hours, schooling, interests, pay, etc.) rather than the most good. Kinda reminds me of our recent guest lecturer in how he forgoes his own happiness (3rd marriage, etc.) in pursuit of what he thinks is the greater cause. I'm not convinced that this level of sacrifice is worth the benefit. Would he still teach if it were a volunteer basis and he couldn't afford a house or a family? Just like the airplane manuals with the oxygen mask diagrams, I think I need to take care of myself first, at least minimally. I think he serves to offset the corporate mindset, although a bit too idealistic, a bit accusatory, and a bit hypocritical. I would listen more to a practical approach.
That physician is very wise and I do think it's prudent to know your audience so you can get what you want. But I still think there is value in emotional appeals. What about the March of Dimes (when it first started), or the addition of Medicare coverage for people with ESRD, very important advances in public health driven largely by sad stories?
I think our professor is mainly training us how to think, important things to consider which should drive us to act compassionately. That's very a very different objetive from training clinicians on business tactics...
Excellent post. It's too bad that "right" can't be quantified.
Great post! I love Aravich as well, have the utmost respect for him and his work, and I think he is probably on of the best teachers I will ever have. Sometimes, though, I feel that he gives off the impression that he is operating under the assumption that we are all science robots who have no idea about what is going on in the world, and have no prior appreciation for the injustices he mentions, which can frustrate me. He is an interesting character, and it has been interesting to see how our classmates react to him; I feel like people's opinions on him can be telling.
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