At the Gregg Stracks Leadership Summit this September, PCP chapter leaders from around the country learned some of the skills needed to mobilize for better primary care training on their campuses. Among those skills, students learned to tell the story of why they were drawn to primary care, also known as The Story of Self. Here, Daniel Kim, a summit participant, shares his story.
By Daniel Kim
I like to solve problems. The engineer in me loves a challenge as well as the creative process of finding solutions. I also care a lot about people, particularly the suffering, the impoverished, and the vulnerable of this world. My faith commands me to “seek justice, encourage the oppressed. Defend the cause of the fatherless, plead the case of the widow.”
These two things led me to medicine. I saw that there were grand challenges in health care, both in the molecular puzzles that held the key to treatments and in the health disparities between those with resources and those without – the oppressed, the fatherless, the widows.
Initially interested in global health, I soon came to see that there were important problems to solve in our own medical system. The disparities in health services showed two Americas: one America has the means to achieve the best outcomes medicine can offer; the other offers health services and outcomes comparable to those of a developing country. I began to wonder. Was it a lack of technology? Was it a lack of money? Was it negligence on the part doctors?
I began to read what I could about American health care. I took classes on health policy and the culture of Western medicine. I learned of the peculiarities of the public-private system and slowly navigated the payer-patient-provider triangle. I began to understand the curious incentives of American health care – which pushed well-meaning doctors to procedures over preventive medicine or lifestyle interventions – and the structural barriers to change for the better. I discovered that it was neither lack of technology nor of money. The structure of the health care system and the culture of American medicine were what stood in the way of improvement.
During college, I shadowed a general internist who served an impoverished population. One of her patients, whom I’ll call Rosa, couldn’t afford the medication she needed. The internist spent a few minutes trying to convince Rosa of the importance of these medications, but Rosa simply could not pay. Back at her office, the internist mentioned to me privately that this was an unfortunate, but common, problem. I didn’t see much emotion or consternation over the predicament. Her lack of emotion might have come across as unfeeling, but to me it spoke to a weariness borne of many years of serving this population and seeing little change from the community or the medical establishment in making care more effective and accessible. This picture, of a deep-seated inertia, affected and disturbed me.
Entering medical school, I had not yet reconciled my interests in the molecular and in the human. I learned the science of medicine, and marveled at the wonders of the human body. I also learned the humanism of medicine, along with health policy and population health, and understood that many problems could not be solved with science, but with conversations and patient education and behavior change. To my dismay, I also saw that well-intentioned medical professionals could cause harm, unknowingly, because the health care system does not align their best interests with those of their patients. I began to wonder, could I unwittingly become part of the problem?
That was when I fell into our school’s chapter of Primary Care Progress. I met people who were wrestling with the same concerns. I realized that scientific inquiry is not at odds with social justice but is crucial to good care, particularly when it is tempered and strengthened by compassion and patient engagement. My scientific skills could be harnessed to bring rigor and understanding to the problems of preventive medicine and primary care in America. Scientific innovation needs to be brought in equal measure to what we do in our general clinics and in the health care system as a whole.
So I began to see hope. I began to see a future where innovation in health care was closely linked to innovative community engagement and primary care practices. I began to believe that primary care could be exciting, and a place where the great passion of medical professionals could meet the world’s great need. And so I ended up at the Gregg Stacks Leadership Summit, where Primary Care Progress chapter leaders learned to mobilize on their campuses to affect change in primary care, and I have been encouraged in continuing to question and challenge and disrupt the “right” thinking in medicine. Since then, I have been involved in a design and innovation class at the business school at Stanford, where we are looking at new ways to tackle obesity and diabetes in under-served populations. Combining thinking from the design school and strategy from the business school, we hope to be creative in our approach to these intransigent problems.
I still like to solve problems. The current state of American health care is one of the biggest problems facing our nation today, and I intend to be part of the solution.
Daniel Kim is a second-year MD/PhD candidate at Stanford University School of Medicine. He graduated from MIT with a degree in Electrical Engineering and Computer Science. He is interested in chronic conditions and optimizing the role of health care for patients with such conditions.