“During the Korean War, the Navy kill ratio was twelve-to-one. We shot down twelve of their jets for every one of ours. In Vietnam, this ratio fell to three-to-one. Our pilots depended on missiles. They lost their ‘dog-fighting’ skills.”*
~ Jester, Top Gun, 1986
I remember seeing the movie Top Gun in the mid-1980’s and how this quote struck me … and believe it or not … it has informed much of my work in healthcare.
Fifty-one years ago (1964) the Hippocratic Oath was rewritten by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, to include (excerpts):
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.
… may I long experience the joy of healing those who seek my help.
With this is mind, and in the blog post How a lack of empathy affects our healthcare I made note …
“Thirty years ago, medical schools taught that the most important component of a mental health healing encounter is empathy, human connection, and authentic relationship between a physician and patient.”
And yet more recently we healthcare leaders have evolved the healthcare delivery system to include:
· Clinicians triple booked every 15 minutes
· 8 to 12 minute office visits
· The I-Patient (to borrow from Dr. Abraham Verghese) replacing the actual patient
· Patients being dehumanized and becoming a diagnosis rather than a whole person
· Clinician focus turning away from the human being before them and toward electronic health records, target organs and test results
· Technology becoming the solution focus rather than a tool
· Care teams held to the same productivity standards as clinicians (as noted above) and yet providing less continuity for a patient with “their” clinician
· A model which rewards excessive tests and invasive procedures
We have switched from “dog fighting” i.e. avoiding overtreatment, establishing and ensuring human connection and authentic relationship, and finding joy in healing to “missile dependency” i.e., the “evolved” model described above.
In our effort to make things better we have forgotten why we are here in the first place. We have sought “missiles” to improve the broken system. We have lost our way. And we are harming those we are honored to serve.
If we truly want to improve the health of our patients, families and communities, it is time to break our addiction to missiles and reconnect with the Hippocratic Oath, what was taught in medical schools thirty years ago, and to our patients, families and communities.
For only then will we truly innovate healthcare.
It’s not too late and yet long overdue.
* As both an animal lover and someone who desires peace this analogy was challenging and yet hopefully lends itself to creating a compelling argument for the need for dramatic change and improvement to our healthcare delivery system.