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Monday Jan 16, 2017

Don't Throw Away Your Shot to Make the World Better

After spending an inordinate amount of time listening to The Hamilton Mixtape during the last few weeks, it dawned on me that we as physicians can really learn a lot from the story being told in this extension of Lin-Manuel Miranda's musical interpretation of the Alexander Hamilton story.

Although the themes of the Broadway musical infiltrate and inform the music of The Hamilton Mixtape, several changes in the lyrics and the presentation provide a distillation of the dramatic themes explored in Hamilton.

One song in particular, "My Shot," serves as the inspiration for this blog entry.

"Ayo mugshot, gun shot, dope shot, jump shot

Take your pick, but you only get one shot

Advice from a schoolteacher to a young tot

Applyin' a sticker to his Spiderman lunchbox

When even role models tell us we're born to be felons

We're never gettin' into Harvard or Carnegie Mellon

And we goin' to end up either robbin' somebody or killin'

It's not fair, that's all they can tell us."

Whether we like it or not, our role as family physicians comes with a unique position in the social hierarchy. Members of the community tend to see us as authority figures. Whether as a holdover from the bygone era of paternalistic medicine or respect for the education and training we have completed, people in the communities we serve look to us for guidance on matters not just medical, but social and (heaven forbid) political. They seek our opinions and approval across all aspects of their lives.

That may seem like a lot of responsibility, and that's because it is.

The first lines of "My Shot" specifically call out the power of the words we use and the assumptions we make in influencing the lives of those around us. People in positions of power -- doctors, teachers, parents -- have to be careful of the words we choose when dealing with most every situation because we never know who might be listening. We might not see what effect our off-handed or well-intentioned comments have on a patient, a friend or a loved one.

So how do we balance our ability to give advice with the patient's search for answers?

Honesty is the best answer. When asked about topics outside of medicine, I make my feelings and opinions known. If I don't have an opinion or enough information to make a statement or form an opinion, I let that be known. I have no illusions that people care about or hang on every word I say, but I do know that things I have said in the past influenced patient decisions.

As frightening as that may be to me, I understand why it happens. We as humans tend to trust both confidence and authority and look to those who exude said confidence for guidance. My fear arises from the possibility of making a statement that guides someone down an unintended path. It makes me careful about the statements I make and the presuppositions I have.

We will all benefit from careful examination of not only our own biases, but all of the opinions we espouse. Information serves as currency and influence in this day and age, and we would do well to be informed about as broad a number of topics as possible. People will benefit far more from our informed opinions than any off-handed or poorly thought-out commentary. In the parlance of the song, we all "need to rise up," and bring everyone around us with us as we educate and care for the populace.

It's not our job to fix all the ills of this world. We as physicians cannot completely stop famine or war or disease. Yet. But if we want to improve the health of our patients and our fellow human beings, regardless of any labels, all of us have to stand up and speak out. We have to be the voice for those who have no voice and represent those who have no representation. We cannot be silent or wait for someone else. We cannot stand idly by as health disparities plague those around us. We all need to "grab the torch and properly hold it."

As the song says, "When opportunity knock', you don't send anyone to get it / Answer the door, welcome it, let it in, or regret it."

Gerry Tolbert, M.D., is a board-certified family physician who practices in northern Kentucky. A lifelong technophile, his interests include the intersection of medicine and technology. You can follow him on Twitter @DrTolbert(twitter.com).

Posted at 03:18PM Jan 16, 2017 by Gerry Tolbert, M.D.

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