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Dreaming of Dreams

By Rich Joseph

I share this personal story in the spirit of a new year…in the spirit of optimism for a bright future. Herein is vision that lies in wait and motivates me each day in my journey through medical school…

It happened at the gym, in a whirlpool. We exchanged pleasantries. Soon came the coy questioning…the naughty teasing…the fiery passion…and then, she took me…

We flirted for years. She enchanted me with her dynamic spirit and gallant grace, but I knew of her smothering demands and pricey habits. I deftly evaded her advances, yet she always returned for the thrill of the chase. Today was different. Using bubbles as bait, the muse of medicine lured me into a debate that left me simultaneously speculative and resolute, vexed and inspired, overwhelmed and lucid.

She embodied herself in Bruce, or so I recall. The introduction came somewhere between his vilification of my future medical career and his cursing the U.S. health care system. I had never met pessimism incarnate, nor had I ever met Bruce, but today I had the company of both. He blindsided me with a bluntness that struck like a sucker punch. It was completely unwarranted, but it triggered a defense mechanism that I had yet to wield with such conviction. Bruce presented a final test. I emerged unscathed, battle tested for the front lines.

I was beyond the point of rationalizing my career plans with strangers, but this guy obstructed a path down which I endlessly vacillated.  To be or not to be an MD? If only Shakespeare had clarified. I am convinced that integrative medicine—the synthesis of disease prevention and treatment—must be the future of health care, but would it be best to effect that transition from within? Should I go the policy route? Or would it be best to take an administrative approach?

By this point, I had a rehearsed response to the frequently asked “what-are-you-doing-now” question.  Dutifully, I told Bruce “I just finished a health policy internship in D.C., I am exploring various interests before medical school, and”—CRASH! It must have been “medical school” Or perhaps “health policy”? Somewhere in my comatose monologue I hit a nerve.

I came to learn that Bruce had been diagnosed with Type II diabetes. Despite the diuretic medications, the edema in his feet had reached the point that doctors discussed amputation. “And you know what I did?” he recounted. “I said (expletive) you to the doctors and I started to swim. Every day, I swim and my blood sugar drops. They prescribe more drugs and try to cut my feet off. Doctors don’t give a (expletive) about health. I get sick, and they get rich. Follow the money trail and you’ll see why the system is so (expletive).” And like that, I became his punching bag.

Yet I empathized with Bruce’s frustration.  My work in D.C. was an eye-opener to the insidious financial incentives of pay-for-treatment “disease care” and the ruinous physical and fiscal consequences of a disjointed system that acts (or more aptly, reacts) downstream. I sensed an alarming disconnect among the health care, transportation, agriculture, food and drug policy spheres, each of which impacts health yet exists as an isolated silo.  Horizontal integration is imperative to craft a comprehensive vision of health.

On the ground, as a personal trainer, each day I see clients who are victims of the communication gap between the medical and wellness professions. Vocations that share such similar values, goals, and patrons must exchange ideas, share knowledge and coordinate health care. As a trainer, I compile medical history reports, monitor physical indicators, prescribe tailored regimens, teach biomechanics, and design dietary plans. I build trusted relationships with other human beings. With weights and sweat, I construct camaraderie and humanity from ferocity. My clients have ranged from elite athletes to obese children, from pregnant women to those afflicted with degenerative diseases. I act as a confidant, a therapist, and above all, a friend who gives his undivided attention and concern in the gym (office hours) and at home (on call). In certain respects, I am literally a physician in training.

A paradigm shift is imperative. True change starts on the front lines and emanates from those who exude trusted expertise, emotional investment, and devotion to the well being of each patient separately and all humans collectively. I thrive under such demands. I told Bruce how I hope to connect evidence-based medicine with wellness to broaden the spectrum of holistic health care. I envision lifestyle counseling, fitness training, dietary instruction, rehabilitation therapy, and medical treatments under one comprehensive health insurance plan. “Physicians must play the central role in coordinating this shift,” I explained.

Bruce chuckled. “So you have a vision, huh? Well, give it up. You went to Yale, so you must have brains. And you know what smart folks do?” he asked rhetorically. “They sell out and so should you. Keep people sick and make money. Now, if by some miracle you become some philanthropic doctor, I will find and congratulate you,” he promised. “But when you start pocketing checks from pharmaceutical reps, just think of me saying, ‘I told you so’.”

I returned the challenge with a grin. The muse was singing and I sang back. “I appreciate the advice,” I responded, “but I train for unknown terrain.”  I thanked him in earnest. If Bruce is a man of his word, I eagerly await his future visit. 

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