Joseph Campbell quoting Sri Ramakrishna, said that one should “seek illumination as a man with hair on fire seeks a pond.”
Anyone in public health, faith, academic medicine or healthcare has hair on fire. Where is the pond?
For many years academic medicine has thought that the pond was the great pool of knowledge about an every-growing panoply of pathological its: cancer(s), sickle cell, diseases of the eyeball and toe and the astonishing kinds of it that collect in our arterial plumbing or lungs. And who could forget the terrifying varieties of viral “it?” Then we begin to think about the chemical it-things we humans have invented that turn out to cause breakdowns and flare-ups that weaken and kill. I’m thinking tobacco, here, partly to not think about the thousands of industrial chemicals.
Focusing on the pathological itcreates a warrior mind tuned to threats and maladies. And they are there to fight. We have built vast castles of learning designed to penetrate the veil of complex secrets that threaten us, all in the service of defending individuals against whatever it likely to kill them. If you are walking around over 40, you’ve probably benefited from this kind of knowing.
Partly because of all this accumulated it knowledge many itproblems have shifted being treated and fixed to conditions that can be managed, often over a period of years, sometimes for the rest of one’s life. That’s good. The it of diabetes or sickle cell doesn’t go away like a broken arm; it can be managed. The it takes place amid a phenomenon called a life. Because you can’t begin to apply all the sophisticated it knowledge without theyknowledge.
This is all difficult for academic medical centers (AMC) like the one about to employ me because a vast and expensive apparatus has been developed and justified on the basis that its research into it would save the world (or at least extend the lives of its people). The reality is that an AMC is an expensive way to provide evidence base care compared to a integrated system of care that can focus purely on applying what is already known, especially to compliant it type problems. Think about surgery and notice all the outpatient free-standing surgery centers in your town. They just do the procedures and leave the research to others.
The AMC is only a bargain when you need to learn something new or push the edge of technology, practice or …integration to a new level. Then you need all the smart and wise people you can hire.
AMC’s today need to turn our attention to the life journey of people and a more expansive breadth of their lives to get the fruits of 21stcentury science into those lives. AMC’s know about bits and its, but not much about life. Hence, the burning hair.
This is true at even the most basic issues: why poor people choose to come to the emergency room instead of a perfectly nice and convenient clinic built just for people who are poor. We need to understand they. (And why don’t they act like we expected?) Science is befuddled. What kind of relationship would we need or want with them? This is a lot better than thinking of people it-type problems. But you can feel how far it is from knowledge one could act on.
A few weeks ago the senior management team of Methodist Healthcare met in one of our churches in a zip code we knew contained the largest number of our charity care patients. Chuck Utterback, the regional representative for CIGNA attended and turned on the lights for us by pointing out that that same zip also was home to 8,970 of their members who we cared for, including 1,791 FedEx workers, 1,724 Memphis school employees, and 1,466 people who worked for the city or county government. Oh, and 459 of our own employees! We not only have hundreds of church partners in hard places. We came to find them and found….us.
The pond that is the answer to our hair on fire is finding us.
It should be a lot easier to learn about the life we part of than about a microbial it. There are extraordinary springs of data that can tell us, not just what zip codes to learn about, but the neighborhoods, streets, homes. And we can see who else we already know – our churches—lives down the block to help teach us what together we could do. And the payoff is much quicker and more predictable for everyone –the full us. Way better science alive in more lives cheaper. And, I think, closer to what God had in mind.