When the Hippocratic Oath Gets Disrupted: Notes From the field

What happens when a doctor and a patient re-design the healthcare system from scratch taking into account what it means to be sick and not know why?

What happens when a doctor and a patient re-design the healthcare system from scratch taking into account what it means to be sick and not know why?

This is the story of an extraordinary Medical Doctor (MD), Dr. Ayesha Khalid, who has discovered early in her career that the medical profession lacks of some fundamental innovation, in the way the doctor-patient relationship entails but more importantly on how the diagnosis of a problem can be successful.

But let's start in order.

Ayesha's story starts, as far as I can remember it, with Ayesha being a top performing systems thinker in a course I was teaching at Harvard, back in the summer 2011. Ayesha's innate curiosity was driving her to reconsider the many years of medical school, often unchallenged in their premise. There was a new discovered unrest as we were dealing with loops, delays and maps and her deeper understanding of her career was being shifted by the minute. Talking to Ayesha, she recalled her time in Medical school, when the medical training was rigorous and formal and certainly abiding to a superior order of things. As surgeon to be, she was expected to be technically brilliant in the operating room. It was a matter of honor and tradition, keeping the patient safe and doing a good surgery. As she mentioned once, "there is more and more of a tendency to learn more about our own niche fields rather than looking at the world around us and engage ourselves in deeply rooted questions of significance".

But this is not just the dilemma of any medical school student. It becomes even more exacerbated and amplified, as the newly graduated MDs move in the sub-specialties and the sense of statutory badges honors to achieve; an impasse that generates a paradigm of immobility. The same she found herself falling into.

But Ayesha's story, the real one, begins when she met "Charlie". Charlie and his family demonstrate the difficulty of being able to have a conversation with their doctor in an era when we should have great conversations. Charlie is sick with cancer in his brain.

But the discovery does not occur out of the process driven methodology of the MDs who visits him and diagnoses him with all sort of pathologies, but the right one. Charlie's story is not just about the lack of answers he is provided as physicians are stretched to provide care in a non-coordinated system, it highlights a common patient experience in the US. It brings up the underlying issues of malpractice and the legal repercussions around it, especially in the US, which tops the chart of most litigious country on earth. It is a story of ill-conceived relationship between patient and MD, which satisfies an established protocol and an allocated amount of time per visit, rather than a sincere interest to investigate the causes, which may deprive a person of his health.

As Ayesha nicely states it, it is the incremental pressure in the profession, to comply with a certain type of risk free demeanor, which has caused us all to ignore the fact that a healthcare system that is designed from the user perspective, asks us to start from the point of view of the patient.

If a patient was designing the healthcare experience, what would it look like and how would we create it?

In order to do this, we need to ask a different set of questions and we need to ensure that the doctor patient relationship is meaningful- and the doctor is able to connect with colleagues in a non-rushed fashion.

How many of us have been through or know someone who has been through an experience in which we felt we were not heard as patients and unable to translate our symptoms into a series of steps that helped us to get to the answers? And how many practicing physicians went into medicine - fundamentally - to help people, because they were following a vocation? How does a better-architected system enable that to occur?

Ayesha's dilemma is the one of an inspired MD who has gone through an awakening, shaken by circumstantial and fortuitous instances, like a University course with fellow students, few summers ago. Her ability to step back and look at the nature of the questions that MDs were asking, allowed her to see a greater old truth. The same one that got her into the medical profession the first time, but which got opaque and bleak as behavioral norms were replacing the vocational ones.

She advocates today for an innovative Health Care system, capable of living up to the expectations of that Hippocratic Oath that moved into oblivion, for many MDs who think that waking up in the morning and going to a clinic is a job like any other. Well it isn't. it is a job of privilege and as such, it should be experienced and designed accordingly.

Will she succeed? Of course she will. This op-ed is a testimony of her impact already and all it takes is to watch her on this TEDx talk, to understand why she will reform the Health Care Industry. She is a systems thinker after all, so her limit is... her map.


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