Health column: What role will you play?

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Ed Ward, M.D., is a hospitalist at Mayo Clinic Health System in Red Wing.

Along the way in my job as a doctor, I've seen things done for reasons I don't understand, and sometimes learned new things that I'm very surprised no one told me sooner. That got me thinking hard about why doctors in particular and people in general do so many puzzling, irrational things. I've decided a big part of the explanation is the strong human tendency to fall into roles.

As a father of three children, I've seen my kids play make believe when they were little and assign roles to one another. Children love role-playing. They play princesses and thieves. Good guys and bad guys. Their imagination is worthy of dramas typically created in Hollywood.

Their imagination in role-playing sparked my curiosity. I've often wondered how we come to play the roles we have in life.

Doctors, lawyers and politicians play their roles in their respective environment. Humans mostly behave as expected for their social rank. Well-behaved kids listen to their parents and grow up to do what their bosses tell them to do. Senior leaders direct mid-level managers who oversee frontline and factory workers. Many people serve as small cogs in huge corporate machines. Complexity and social hierarchies can hide fundamental truths and even doctors may act ignorantly if they never question their roles.

I've done this myself. I went to Johns Hopkins Medical School and worked 20 years in clinics and hospitals without ever learning the vital fact that Americans suffer the worst health in the industrialized world. The National Institutes of Health confirms the United States ranks last among other developed nations when it comes to access, quality and equity of health care (See footnote).

Much of the great success of 20th century American medicine came from opposite core values first proposed not by doctors but by a school teacher. Working for the Carnegie Foundation in 1910, Abraham Flexnor wrote a scathing inquiry exposing many private medical schools as mere apprenticeships in snake-oil salesmanship. His influential report prompted most medical schools to join with universities and uphold strong scientific standards. Medicine advanced through randomized trials looking at survival. By 1969, doctors were part of a society so dedicated to scientific progress that we put a man on the moon in just nine years' time.

I want American physicians to return to the twin pillars of rigorous science and patient benefit they followed so successfully in the last century. The American College of Physicians supports evidence-based reforms to improve care and reduce costs. Improved health care financial structures may also promote better health.

America badly needs another Mr. Flexnor. Can you play his role? Wake up and ask hard questions. You are more than a cog in a machine; you are a person and a child of God (or of the universe, if you prefer). Question authority. You are more than a creature of habit, emotions and peer pressure. You are capable of rational thought; make the effort. Does evidence support what you do? Does your work contribute to the common good?

To the graduating class of 2017: Question the role you will play in life. Maybe only an examined role is worth playing.

Footnotes:

1. Ginsburg JA, Doherty RB, Ralston JF, et al. Achieving a high-performance health care system with universal access: what the United States can learn from other countries [published correction appears in Ann Intern Med. 2008;148(8):635]. Ann Intern Med. 2008;148(1):55-75