In the hubbub of holiday hopes and wishes, I'm reminded of how I strategically hung a 16” x 20” cartoon poster of Ziggy in my kitchen after my diagnosis. He was standing atop Earth, smiling at bright yellow lettering in a night sky that said “Keep hoping, keep wishing.”
Ziggy's urging became my touchstone, an often repeated mantra to encourage my three little ones—and me—with one message: “Don't give up, however huge the challenge.”
As indescribably useful as that was, the richness of Ziggy's wisdom was lost on me at the time. Hoping and wishing are different. Hoping is the feeling associated with the belief that the possible outcome we desire can happen. I hope I never have cancer again. Hopes thread through our lives, mobilizing us to action when we can affect the outcome and helping us wait when we can't.
In contrast, wishing is the feeling associated with the notion of getting something that's only remotely possible, if possible at all. I wish I'd never had cancer. Wishes are emotional candy. Wishes make us feel good for a moment but usually don't change our outlook or affect what we do.
I'm not dissing wishing. After all, Ziggy specifically instructed us to keep hoping and keep wishing. I can understand why. Indulging the occasional fantasy can provide respite in tough times. And wishing sometimes helps us find hope.
I remember one afternoon of weighing treatment options. Not liking any of them, I wished for treatment that was non-toxic. Articulating that wish helped me accept the reality of my limited options and focus on a useful hope: the hope to choose my best option, a hope that then nurtured my hope for the best outcome.
I've been hoping and wishing ever since. This holiday season, some of my most fervent hopes and wishes have to do with the future of clinical medicine. My heart aches whenever I hear clinicians' distress over burdensome regulations and increasing time pressures. With my premed students and my resident daughter in mind, I'm wondering and worrying about how ongoing changes in medicine will impact their ability to care for patients—EMR, HIPAA, Obamacare, diminished research funding, increased specialization, Dr. Google, and on and on.
One question keeps nagging me, hounding me: “What can we do to affect the direction medicine is headed?” Today's changes feel too big and their momentum too great for any of us to make any difference, whether we're practicing or retired.
In search of insights, I began reading popular histories of disease, such as best-sellers about smallpox, cholera, TB, and AIDS. From colonial America to 18th Century London to modern West Africa, the stories share a singular theme: progress in medicine depends not only on scientific discovery and technological advances, but also on overcoming obstacles to acting properly on what is known. Politics, economics, communication, and culture, to name just a few, have the power to impede or facilitate progress in patient care and public health.
Those histories provided perspective. The details of today's challenges may be unique, but their magnitude is not. The obstacles to progress in patient care and public health have always been huge—and likely always will be.
Those histories provided inspiration, too. Yesterday's heroes of medicine—like Jenner, Snow, and Koch—doggedly pursued the truth about how to change the course of disease. They showed courage and determination by risking their lives in dangerous situations or risking their careers with unpopular ideas. And they never tired of advocacy, influencing leaders in the scientific, political, business, and spiritual communities to respond properly to the threats to patient care and public health.
The subtext of their stories offers a testament to hope. Yesterday's heroes never gave up. Each of them kept hoping they could make a difference and then acted on that hope. That insight offers a starting point for answering my question. What can we do to affect the direction medicine is headed? We can keep hoping. Keep wishing.
I wish we could find cures for cancer—for all disease—as fast as humanly possible. I wish that when clinicians concluded each patient visit, it was because they'd completed everything they needed to do, and not because they'd run out of time. I wish patient care was driven only by what's best for the patient, independent of financial concerns.
Those wishes lead to many specific hopes. I hope for better funding of trials. I hope that more doctors talk with their patients about trials. I hope for one universal EMR designed primarily to facilitate patient care.
As 2015 draws to a close, my greatest hope is that clinicians don't give up their hope for a better tomorrow. I hope that wherever decisions that affect medical care are being made, someone asks “How will this improve clinicians' ability to provide expert, compassionate care?” Sharing a moral vision of advancing patient care and public health can create—and I believe, will create—the ripple of momentum needed to overcome the obstacles to progress.
I'll close with a different kind of wish: a greeting. Such wishes bind us together in fellowship, whether wishing each other a safe journey or renewed health. In the spirit of the season, I wish you Happy Holidays and a New Year filled with joy and hope. We know the challenges for clinicians will continue to be great and the progress slow. Let's heed the words of Maimonides and let the love of our art inspire our work.