The Shaky Ivory Tower

It's interesting to think about the evolution of medicine over the past millennia. I had a conversation recently with a gleeful man from Uganda. We spoke of ways of life, taxes, forgetfulness, and about my new job. He came to the US alone from Uganda around the same time my family moved from Kenya. He has been in Madison, Wisconsin for just over a year now and sometimes his driving betrays his air of familiarity with his surroundings. He told me he drives many people to Epic but he has never really understood what it is we do here, and gauging from the verbal collage he offered as his understanding of the company, it is clear neither do many of the employees he has driven. I started by telling him that most doctors in Uganda likely use pen and paper to keep record of health information when he goes to a hospital back home. But here, with Epic, when he goes to UW-Madison Health hospitals and sees a doctor, the doctor uses software to manage healthcare delivery instead. Moreover when he might fly back to visit some of his family in California, and might visit Kaiser Permanente, he will find they already have all his history and records. That is all enabled by Epic's software.

More interesting to me, however, was the realization I had later that day that patients today are completely disconnected from healthcare delivery; from how the proverbial sausage is stitched. Healthcare practitioners have devised over the years a highly complex, esoteric language and workflow to provide health to people who are least aware of what is being done towards achieving health. These highly skilled, highly educated technocrats have unknowingly marginalized the very center of their profession: the people. Now, indeed a patient might not need to know the nuances of how a doctor handles healthcare, but in all cases the patient should be shoulder to shoulder with the doctor in a collaborative, evidence-based, team approach to improving the health of the patient. If one thinks back to how medicine started, we were a group of more quacks than actual learned healers. Ranging from everything from Asclepian temples to herbal medicine, a doctor was never at the forefront of what it took to heal but served more as a mediator for the patient and their health goal or illness. It seems at some point the ill patient was taken advantage of and medical professionals have stepped far over the sick, in pursuit of treating the same man they have left behind.

Healthcare needs reform on many levels but it needs to put the patient at its heart. We will never achieve our lofty goals if we continue to build on ethically ambiguous grounds. Transparency is not just one of the goals; transparency should be the primary goal in a field centered around care for the vulnerable. Anything more opaque is entirely misguided and costly in both monetary and human terms.