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The Split in Medicine

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We are undoubtedly in the midst of the biggest medical crisis this country has ever seen. There are so many pressing issues that need to be addressed. Are you for or against Obamacare? Do you prefer managed care or indemnity coverage? Private vs. government administrated? Do you believe in conservative vs. aggressive approaches? Are you for traditional medicine and against holistic medicine, or vice versa? Think drugs are the answer to health problems, or over-prescribed? Should we opt for medical vs. surgical approaches, or the other way around? Should insurance companies and the government dictate the standard of care or should that be decided upon by physicians themselves? Should we only be seen by a physician, or is the PA qualified to administer diagnosis and treatment? We have many issues in medicine today that have caused people to rally around very different opinions and we find ourselves severely split into many factions. While there is no question that these issues, as well as many others not mentioned here, have split the public opinion as well as the opinions of doctors, are these really the true issues causing the split? All of these issues have arisen from a change in the needs of the patient population as well as financial issues in health care delivery. But this is not the "split" I am talking about. None of the issues facing doctors and patients today will be solved by directly answering any of these issues.

We have a long list of problems and are trying to solve them by creating a long list of "what" we need to do to fix the problems. We fight over "what" we need to do to fix the problems. We fight over how we can achieve a more successful system. And all of this is real and true. No doubt. Yet, at best, all of this is symptom-oriented. In medicine, if we don't look at the mechanisms of any condition, the best we can hope for is symptom control. The same is true for all of these other issues plaguing medicine.

However, the "split" I am talking about is not about the arguments we engage in to determine what we need to do to "fix" things. Let me clarify. At the turn of the 20th century, medicine began to take on a totally different look. Science and technology enabled many researchers and physicians to find better, more reliable and predictable ways to care for the medically suffering public. Why did these people dedicate themselves to years of research? Clearly, the inspiration came from a desire to relieve human suffering and improve the human condition. This is "why" medicine in this country made all of the advances it has made. The focus on "why" we do what we do -- improving the human condition -- was the fuel for the evolution of the greatest medical advancements in human history.

In order for progress to occur, or for any endeavor to be successful, it requires dedication and commitment to succeed. This can only be accomplished by people who are genuinely dedicated to the reason "why" they do what they do. When we are connected to "why" we do what we do, we have the commitment necessary to discover "what" we need to do to make the why a reality. Therefore, why and what need to remain intimately connected. Herein lies the basis for understanding the split I am talking about.

As the population grew, and food, water and air quality diminished, we saw a linear increase in the amount and variation of disease and pathology. And the new connection to solving these issues is "what" should we do. "What" we need to do speaks to the increase in symptoms so the focus has been on relieving symptoms. But let us not forget that why we do what we do is to relieve human suffering and improve the human condition. Unfortunately, focusing so intensely on what we do (without the concomitant focus on why we do it) takes us away from the stimulus for growth and into the world of "finger in the dyke" medicine. The split between why and what is eloquently articulated by Simon Sinek, best known for popularizing a concept of human motivation in his book on the same subject, Start With Why: How Great Leaders Inspire Everyone to Take Action (2009). In it, he delves into what he says is a naturally occurring pattern, grounded in the biology of human decision-making, that explains why we are inspired by some people, leaders, messages and organizations over others. He illustrates why some companies continually succeed year after year and why others fail. It is the split between "why" and "what" that undermines success. In other words, success starts with a dedication to why. It is then met by what needs to be done to succeed. As the why and the what stay aligned, then growth and success are predictable. However, when what takes over and why begins to trail off, we will see even the best of companies with the best products to offer on a collision course with failure.

In essence, this is where we are at in medicine today. We are throwing around many ideas relative to "what" we can do but we have allowed "why" we do what we do to trail off and be forgotten. The altruistic desire to improve the human condition has been replaced by stopgap solutions with financial goals and considerations.

If we want to heal the "split" in medicine, we need to enliven passion for who we are... all people on the same journey. When we stay committed to helping each other and our belief systems are aligned, then we will solve the mechanisms and reunite why we do what we do with what we do to achieve our goals. We need to stop treating symptoms and start addressing mechanisms. Until then, we will continue to attempt and fail.

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