We have been back in the U.S. for over three months. This has been a time of much transition for our whole family. The boys have started at a new school, we have moved to a new house in a new city. We are learning new traffic patterns, new roads, new grocery stores, making new friends and more. And amidst all that I have been doing a lot of thinking about medicine, my personal life and how they merge to LIVE IT. I’ve been reflecting upon how my experience in New Zealand has shaped me. I’ve been trying to catch up on the Affordable Care Act and its implications for primary care and healthcare in general. I’ve also been catching up on social media. It helps me feel connected and also is a means by which to share my messages about health.
So, this week the following things converged as I:
- Read a chapter from Clayton Christensen’s book The Innovator’s Prescription
- Listened to the Public Forum CD from April’s Nutrition and Health Conference with Andrew Weil
- Learned about an iPhone app called Food on the Table
- Reading Atul Gawande’s August 13th New Yorker article, and
- Read Bob Wachter’s comments on keeping the “A” in SOAP
And then a light in my brain went on.
The words of one of my friends from New Zealand repeated in my mind. She is a palliative care nurse and a foodie who loves the preparation and sharing of food. She kept saying, “Why do Americans say they ‘fix’ dinner? It implies they take it out of the box and put it on the table.” Where is the creativity and community of preparing and sharing food? Where is the connection to nature? How has it become such a chore? Is it now at the mercy of marketers? Who adds the spice?
We can ask the same questions of health care. We are certainly on a quest to “fix” healthcare. We analyze the process and resources and try to refine it. There is a place for that. There is a lot of waste in the system. I am not an expert at manufacturing, but I am an expert on caring for people, listening to them and helping them improve their health. And I do think we try to come up with a “fixing” formula that we are risk of forgetting the spice of life. And I am also certainly not a gourmet chef, but I do know my children need good tasting, balanced nutrition and sit down meals.
So, there it is in one word: FIX. That’s my issue. I don’t know what to fix for dinner and I don’t know how to fix medicine. And all this stress emanates because something just doesn’t feel right to me about the packaging. We can’t forget the spices!
I think lack of spice or human moments is a major factor in physician burnout and patient dissatisfaction. We as physicians may have to be “cowboys converted to pit crew members.” Yet we are on a quest to maintain some of this spice in our interaction with patients. Yes, the patient experience is not only an end-user customer approach, but a physician-patient experience which is a human experience that allows for something organic to occur. We can’t become so focused on putting the final product in a box, or tracking all the checked off boxes of an EMR, that we forget why we are all at the table in the first place.
Ask anyone in our family what we missed of the US while we were in New Zealand and that was a dishwasher. At first I thought it would encourage us to have some good family time together. Ha! I bought a large basin so we could put boiling water in it and streamline the cleaning process. We set a schedule for who had which job, and it all fell apart as we became busy with school and work. We wanted to enjoy the beautiful sunsets and not be stuck in the kitchen washing dishes. It affected what we “fixed” for dinner. The less dirty dishes the better. They are wonderfully environmentally conscious in NZ, and paper plates were not an option. But in our small town, neither was going out to dinner often. (We certainly frequented a few places!) And the grocery store had so much less variety for this spoiled American, I struggled with figuring out what we would eat even more than I had in the US. Now, the culinary variety of the Kiwi diet often included sausages on buttered white bread, heavily greased fish and chips and meat pies.
I wasn’t sure what I wanted to “fix” for dinner anymore while we were there. I joined a wonderful CSA, learned about quince and feijoas, and found lots of delicious ways to prepare red snapper. I admit that food planning and preparation were a struggle during our stay. But it was also part of the learning growth of being there. Key tools such as a dishwasher have potential to make it easier or an excuse to make it harder.
One of the many lessons I have taken away from my international experience is this analogy of fixing dinner and fixing healthcare. As a working mom who recognizes the importance of nutrition for myself and my children, this issue is close to home. It also resonates in me as a physician. Of course I want a quick and easy answer. I want it all “fixed.” But it should be an interactive process, both in preparing food and treating patients.
This doesn’t mean we can’t be efficient or easy at times and more elaborate at others. At all times our work needs to be mindful. As we continue to streamline processes, both at dinner and in healthcare, we can’t forget the spice. What we prepare needs to nourish us and taste good!
Ok, now I’m signing off to prepare my family’s dinner. What will you have tonight?
Image | Don LaVange, Creative Commons