Optimism and Despair

What drew me first to the world of medicine was the sense that stories were essential—even elemental—to the provision of patient care. The paradigmatic provider-patient exchange, that of taking a history, features doctors and their patients working together to weave a narrative, to make sense of pain, and to ultimately address somatic and psychological suffering. Thus in undergrad, before med school, I spent much of my time thinking about what stories we tell each other about how health care apparatuses developed and took shape, how different marginalized communities imagine and experience their relationship to medical institutions, how the American public at large makes sense of medical science and society.

One dominant narrative within this imaginary is that of the infallible doctor—physician not as frail, emotional, conflicted human but as extension of medical science itself, enacting healing in the name of logic, rationality, and algorithm, performed with the precision of a scalpel. This simplistic story, indeed, likes to distill the entirety of the American health care system into the singular image of the doctor. I am thoroughly fascinated by the counter-narrative that patient safety advocates tell: that medicine, for all its promise and achievement, is as infinitely fallible as it is successful. Tubes go in the wrong places; the incorrect pills are dispensed to an unsuspecting patient. Doctors, shockingly, get tired; they too are mortals, subject to the whims of exhaustion and exceeded duty hours. They make mistakes within a medical culture that likes to deny the existence of mistakes, preferring erasure to recognition and correction.

Needless to say, this story sounds profoundly depressing. And I heard it told and preached many times throughout my college years in public health and sociology classes. It is all too easy for doom and gloom to dominate rhetoric about the health care system—especially in conversations taking place within the ivory towers of academia—and it seems that the cumulative effect of these denunciations of the US health care system is to foment inaction, rather than propel change. For me, attending Telluride this summer is both about rediscovering my own optimism about changing entrenched systems and considering how other health care providers are thinking about and practicing within such a system. There is something to be said about the potential of focused collectivities, of small groups of people interested in large changes—and I hope Telluride proves to be such a place.

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