We’re told, over and over again, about the failure of medicine in America.  About the tragedy of our system, the horror stories of care unavailable, the misery of lives unprotected, the cost of surgery and medicine and hospitalization.  The public is inundated with the information that medicine has failed; that only the government, that great bumbling knight on the lame white horse, can ever come in and make sense of the debacle of American healthcare.

Well, I doubt it.  I think, on the whole, that we do a bang-up job taking care of untold numbers of people.  I think that we exhibit enormous care and compassion to those we see.  I also think that the news is not, as the AMA says, ‘one in seven Americans has no health insurance.’  The news is ‘six in seven Americans do have health insurance.’  That’s good news in an economy as diverse and complex as our own, in which we maintain the freedom to succeed without the weight of a completely socialist tax system.

But I agree with one thing.  Medicine has failed in a very real way.  We’ve failed by refusing to view the humans we see in totality, as humans, and by refusing to make them accountable.

Medicine, rather physicians, has decided that we can treat the body, but not the life.  That with chemicals, surgeries and ‘programs,’ we can make everyone healthier, even as they engage in every form of destructive behavior imaginable.

What we have failed to do is hold our fellow humans to any sort of accountability.  And the reason is that we’re told not to judge.  Don’t judge their drug use; don’t judge their drinking.  Don’t judge their promiscuity and don’t judge their family situations or lack of parenting skills.  And in the process, we have abdicated the influential role we once occupied, and should occupy again.

What our patients need to hear from us, once again, is ‘Tsk, tsk!  You mustn’t do that!’  What they need us to do is advocate for the wholeness, the wellness of their lives.  Beyond organs and bones, beyond the isolated concern for infected genitalia or needle-tracks, we need to remind them that some ways of living are bad; and some activities (however approved by the entertainment industry)  are destined to shorten their lives and leave them miserable on the way.

You see, when we don’t do that, we devalue our patients.  We look at them and say ‘well, it’s his life, he can do what he wants!’  Then we write the prescription and walk away, secure in the deluded belief that we have done our best as medical technicians.  Not professionals, of course, but technicians.  The prescription, the surgery, the referral to the mental health clinic, these become our ways of neglecting our duty.       When we refuse to see the value of each individual life that passes our way, we don’t have to tell them the whole truth, and we don’t have to offer them any solace, and we sure don’t have to offer them any guidance.  We slip in, we slip out, and the transaction is complete.

But what we need to do is more difficult.  More often than we acknowledge, we should look at them and say ‘you’re better than this, you know?’  We need to look into the eyes of the Meth addict and say ‘I know you can do great things; so you have to stop using drugs.  It’s criminal and worse than that, it’s ruining your life.  God made you for a reason and it wasn’t to use that garbage.’

We should look at the ‘baby-daddies’ that accompany poor, confused, pregnant little girls and say ‘Did you do this?  Are you going to take care of this young woman and the baby you made?  Or are you going to knock up a few more, eh Casanova?  Is this child your responsibility?’  We can be the defensive father or mother that girl-child lacks, if only for a while.

We ought to look at the parents of the teenage pregnancies, or the parents of the girls who will be pregnant, who are on oral contraceptives at 14, and whose boyfriends stay in the room for their pelvic exams, and say ‘do you want your daughter pregnant by this boy?  Are you crazy?  Don’t you know how hard this will be for her, and that he will give her a disease and abandon her, or else beat her and the baby?  Or ‘Son, do you want to marry this girl, or live with her, her crazy parents and that Chihuahua that you know is somewhere in the house?’

And when married men or women, or any men or women, come to us with STD’s, we need to caution them about how unfair it is to share that joy, how cruel it is to take it home to a spouse, and how they need to be more responsible.  Because what happens in Vegas, or Manhattan, or San Francisco or Cancun never stays there.

The teenage drunks need us to look at them and remind them of how adult drunks, old drunks, miserable drunks live.  And when we see drunk drivers, we should all do what I so often do.  That is, I say ‘you could have killed my wife or children.  Is that what you wanted?’

See, one of the reasons health-care in America is expensive and overwhelmed, is that individuals have no sense of their own worth, and no sense of the worth of anyone else.  And because families are struggling with infidelity, divorce, selfishness and abuse; families which were once the starting point and anchor point for proper behavior and attitudes.

People just aren’t taught how to live and how to behave.  And part of that education would have been learning right from wrong, learning to follow a set of moral/behavioral rules that lead to health and good relationships, not misery, drugs, drinking and disease.

As long as we sit back and write out drugs, nodding our heads and congratulating ourselves on our enormous cultural sensitivity and tolerance, all we’ll do is enable more misery for generations, and ennoble (by our silence) the very behaviors all of us pray each night for our children to avoid.

You know by now that I’m a Christian.  Worse than that these days, I’m a Southern Baptist Deacon.  But I’m not even saying we have to evangelize.  Most of the world’s major religions agree on some basic moral tenets, like the welfare of the innocent and poor, the safety of children, the value of marriage and family and the worth of individual lives.  So all of us, Christian or Jew, Moslem or Hindu, Bahai, Buddhist, Shintoist or Zoroastrian, and everything in between can at least agree on one thing.  Humans are behaving badly and suffering for it.  And we physicians owe it to them to speak out.

Guess what happens when you do?  I know, because I’ve done it.  They say, ‘Doc, you know, I realize what you say is true.  I’m trying to do better.  I agree with you.’  Or ‘Nobody ever said that to me!  Thanks!’  We are all children of God, and like all children, we want boundaries and rules.  The idea that we don’t is shear post-modern madness.

Some will get mad.  Let them.  Let them complain.  But folks, the world is in a bad way, and much of it because people don’t know any other way to behave.  Let’s offer them our insight, and our wisdom, served up with love and compassion.  And let’s use our medical badge to get close to them, and remind them by our concern that they are worthy of our concern.  The idea will surprise them.

The results might surprise us all.

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