On Becoming a Healer Saul J. Weiner and Stefan Kertesz

In his book, The Present Illness, American Health Care and Its Afflictions, physician and historian Martin Shapiro, MD, PhD, MPH presents a scathing critique of a profession suffused with status, money, and power. At the same time, he also describes many deeply caring and rewarding patient care experiences, his own and those of colleagues.  But these relationships are only possible when the clinician has a clear understanding of the pernicious corrupting forces in medicine and consciously rejects them.  This is a moral act that must be renewed continuously. They also require a capacity to confront one's own insecurities -- Dr. Shapiro describes years of psychotherapy that were essential to his own growth as a physician who can be fully present in the face of suffering.  
Martin indicts the profession for producing far too many doctors who want to get rich and who are unprepared, through a faulty process of selection and training, to be truly caring towards those they serve.  Martin reminds us that the motives of the profession have long been suspect, quoting Plato's Republic in which Socrates asks, "Is the physician a healer or a maker of money?" Never before, however, and nowhere on the scale found in the United States has health care become such a massive industry, one that keeps growing. Martin argues that the profession can only heal itself if it confronts its demons honestly and openly, beginning at the earliest stages of medical training. 

A recent NEJM article and accompanying podcast episode (“Tough Love”) authored and hosted by the Journal’s national correspondent sound the alarm that a culture of grievance among medical students and trainees about the discomforts of medical training is threatening to undermine both their medical education and patient care. She also describes widespread anxiety among medical educators who feel fearful of speaking because of concerns of retaliation on social media.  Absent from the discussion, however, are the voices of students and trainees who, in the podcast, are referred to as “our children.” Medical Students and trainees we spoke with did not feel that their concerns are experiences were accurately characterized. We propose that medical educators are ill prepared for the shifting power dynamics, both in terms of knowing how to listen and how to lead.

“Sonny’s Blues” is a 1956 story by the author, James Baldwin, about a “sensible” and pragmatic algebra teacher and his younger musically gifted younger brother (“Sonny”), who struggles with heroin addiction. Both of them, raised in Harlem, are deeply affected by anti-Black racism.  Although the older brother, who narrates the story, feels responsible for Sonny, he struggles to relate to him. With the help of an English professor, Laura Greene at Augustana College, we reflect on some of the lessons of this story for the physician-patient relationship, especially when caring for individuals with substance use disorder. We explore the cost both to patients and to ourselves, as healthcare professionals, of holding patients at arm’s length because we fear engaging, especially in the face of suffering.
A PDF of “Sonny’s Blues,” can be accessed from the story’s Wiki page (scroll down to external links).

In a 2021 episode that we reran last month, “About me being racist: a conversation that follows an apology,” Saul talked with a former Black colleague after apologizing to her for something racist he had done twenty years earlier that hurt her for a long time.  
Since then, Saul has been thinking about how he got exposed to racist ideas and notions of power as a white male growing up in the United States (in his case in a liberal, highly educated community) and suggested that he and Stefan talk about it, taking to heart Toni Morrison’s admonition that, “White people have a very serious problem, and they should start thinking about what they can do about it – and leave me out of it!”
Also, next month we’ll de discussing a short story by author James Baldwin with a special guest, and would like to encourage listeners to read “Sonny’s Blues,” which can be accessed from the story’s Wiki page (scroll down to external links).

We are re-running this episode from 2021 because we’re releasing a sequel next month in which Saul reflects on his journey confronting racist ideas he’d absorbed and that became impossible to ignore after he’d acknowledged his role in the incident described here.  We are also re-running the episode because it exemplifies our commitment to facing things -- about ourselves and our profession – to enhance our wellbeing, and our relationships with colleagues and patients.  Rather than disheartening, we find such conversations and the changes they bring rewarding and healing.

For years, when physicians order tests to assess lung function, or blood work to determine kidney function, or look up guidelines for managing high blood pressure the results have been adjusted for race. This practice has been based on studies that seemed to indicate that the same result means different things if the patient is Black vs white. So, for instance, an “uncorrected’ creatinine of 1.6 was thought to be less concerning in a Black than white patient as Blacks were thought to have greater muscle mass (not true). These correction factors masked underlying environmental and social stressors disproportionately affecting Black Americans. Regrettably they also contributed to delays in care for chronic conditions, as Black patients had to be sicker than white patients to trigger therapeutic interventions – further exacerbating disparities. We talk with two physicians who lead an anti-racism equity committee based in a Chicago VA hospital to understand the history and science that led to these “corrections,” and how they have successfully been removing them through education and advocacy across their organization and nationally. Their activism is especially meaningful because of its immediate, tangible, benefit for affected patients. The views expressed in this episode are those of the participants and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.