But—and there is a big “but” here—The House of God sells more copies now than ever, it’s all over the world, almost every doctor knows about it or has read it.
Why do you think that is?
Because it is about elemental things. It’s very specifically set in 1973 to ‘74 in an urban hospital in America, but it’s relevant to people’s training as doctors today. They face the same problems. The basic problem is, how do you make a good connection with a patient? As I get older, I realize the most important thing in medicine that really helps people, either directly through giving them some hope or understanding, or indirectly by making it possible to do better medication or surgery because they like you, is the quality of the connection with the doctor. I would say the quality of the connection between the doctor and the patient is absolutely the most important thing in medicine. The rest is technical skill and judgment and all that. But if you have a good connection, and you know how to listen, the patient will tell you what’s wrong with them.
When you talk about the quality of relationship with one’s doctor being very important, my reaction is, “What relationship?”
Right. Now we use all these tests. Doctors have eight minutes a visit or something like that. What chance do they have? Part of the reason so many tests are being done, frankly, is the threat of lawsuits. It never used to be that way. When I grew up, nobody would sue a doctor. And, of course, the main variant in whether a person sues a doctor after a bad result is the quality of their connection with the doctor. Studies have shown that if they like the doctor, they’re not going to sue.
I know from your other works and your website that you like to focus not just on what’s wrong, but also on how things can get better. Do you see any hope for medicine today?
Yes, I do. Go spend time with medical students. They’re incredible people. They’re different than when I was in medical school. They’ve been everywhere, they’ve done everything…they’re very hopeful. Another reason to be hopeful is that over 50 percent of medical school graduates are women, and women are the carriers of connection in our culture, who do the relational work, mostly, and are valued for doing that work, whereas men are not as valued for that.
Another thing that has gotten better is that what used to be called “alternative” treatments are now accepted, for example, Alcoholics Anonymous, and 12 step programs. What the founders of AA, Bill Wilson and Dr. Robert Smith, discovered in 1935 was that telling your story to another drunk could keep you sober. Mutual connection heals people. Not just connection, but mutual connection. They were pioneers of the idea in medicine—now it’s a normal and obvious treatment, but nobody gives them credit for it—that same-disease people can offer support and healing to each other.
A third hope in medicine, as Bill Wilson and Dr. Bob said explicitly in the Big Book of AA, is that alcoholism is a physical, emotional, and spiritual disease, which was the start of the holistic movement—where you don’t treat just physical symptoms. And that’s engrained in medicine now. There is a lot of attention paid to the psychological aspect of disease. There is a lot of that in alternative treatments, like social work, and clergy, and really good doctors who do that, in spite of it being hard.
The last thing is, we’ve got to get rid of insurance companies. Medical care in every other Western industrialized county is better. We’re the only one where the government doesn’t take care of it as a priority. It’s a no-brainer that the only way medicine is going to get better is to have a government-run single-payer system. But if we’re spending half our money on a defense budget, we don’t have the money for this.
Some people are afraid of the single-payer model as being socialized medicine.
People say, “Oh, socialized medicine!” That’s the [pejorative] buzz word. But I recently had a wonderful experience with the single-payer model. My father had lung cancer, and after a while, his doctor said we had better get hospice care. [The doctor arranged that] and the next day my father got two kinds of oxygen tanks, a terrific new wheelchair, a great bed, a nurse on call giving medications in his apartment. How much does it cost? Zero. It was from Medicare, and they were terrific, motivated caregivers.