Over the past three weeks I have been traveling throughout Asia including Vietnam and Philippines. I don’t speak any of the languages, but it didn’t take much to see the culture of community and family.
On one particular day in Biên Hòa, a suburban area one hour away from Saigon, a storm flooded the street. As I stood at the doorstep of the place I was staying at, I watched cars and motorcycles trudging across the high water. I looked at the stores around my area and saw people helping each other put their belongings away, move their scooters inside, and even push cars through the torrent. There was hardly any hesitation in any of their actions – a firsthand example of working for the common good.
In the Philippines, my cousin told me about the fiestas in the provinces. Each province has their own saint, and on that saint’s day, the whole town would celebrate. The townspeople would decorate the streets, have dances, and cook delicious food. The fiesta starts weeks before the holiday and continue for weeks after. On the actual day of observance, families would open their doors and let anyone in to share a meal with them. By anyone, I mean anyone from distant family members to even tourists like me. I didn’t get a chance to partake in any fiestas, but my cousin assured me it was a common practice – a family away from home.
I never fully grasped the concept of justice and equality in terms of healthcare in medical school. To me, it was simply just another ethical class that I can skip so I can go and study for the “real subjects” like biochemistry or pathophysiology. I never knew how important or how real ethics really is. It’s difficult to see the bigger picture if you’re standing right in front of it.
United States healthcare prioritizes the importance of “patient autonomy” – meaning that as healthcare providers we give the patients what they want. For example, in the ICU, dying patients are kept alive on ventilators to buy more time for the family to come together and decide on when it’s time to stop. This might appear to show respect for patient autonomy, but this study has shown that futile critical care can lead to delay of care for someone who needs the ICU bed. The system based on patient autonomy may result in good outcomes in some patients, but may increase hardships and inequity in others.
My vacation to Asia taught me more about family and the community. I saw people help each other during a natural catastrophe. I saw families opening their homes to strangers to share a meal. People there put the community first because family is so instilled in the culture. I’d even go on to argue that people put energy into the community because often times the community would reciprocate back to the people.
A good start to solving the U.S. healthcare problem would be for us to combine the emphasis on patient autonomy with community awareness. If we, healthcare providers and patients, can start realizing that our choices affect the community as a whole, we can make such better medical decisions. It was common for people in Asia to drop what they’re doing to help someone shove their car out of a deluge. Maybe it’s time to treat healthcare the same way. If we all worked for ourselves, we’d drown in the flood. But together, we can push even a two ton car out from underwater. To see the bigger picture, we just need to keep stepping back until it’s in plain sight.
Putting others first doesn’t just apply to medicine and Asia. It can help you be more successful in life as an individual. Success depends on other people’s support.
Nearing the end of my first year at a new and upcoming residency program for internal medicine, I was asked to help choose next years class. From November to January, applicants would show up weekly to be interviewed by the faculty for a position. These fourth year medical students would attend a mixer with the current residents where we would get to know them. At the end of the year in February, the faculty and current residents would meet to choose the new incoming interns. We would have pictures of all the applicants up on poster boards with their board scores, research, demographics, and their hobbies. As we went through each applicant, what stood out most was not their excellent board scores or groundbreaking research. It was whether they would get along with others that racked up the most points.
Unfair or unacademic? Not really. Doctors need to be likable. What good would a super smart doctor do if their own patients won’t listen to them?
Dale Carnegie had some simple rules in his book, How to Win Friends And Influence People. Here are some of the key guidelines that you can apply to your life right now:
- Talk to others by saying their name
- Listen first
- Be genuinely interested in others
- Do the above sincerely.
Be the leader of your community. Give back to what gives to you everyday. The locals in Vietnam and Philippines understood that very well. The US healthcare system needs to catch up. It’s up to us to take the initiative. Be like the successful. Don’t be timid. Think right towards others and surely the energy will come back to you.
Let’s have a fiesta and share your comments below!