致2021年醫學院畢業生的一封公開信
大衛·威爾（David Weill）
2021年6月27日
作者介紹： 大衛·威爾，1990年畢業于杜蘭大學醫學院（Tulane University School of Medicine），肺移植領域專家，威爾咨詢集團（Weill Consulting Group）負責人，斯坦福大學醫學中心高級肺病中心前主任。2021年5月出版回憶錄《呼氣：希望、治愈和移植中的生活》（Exhale: Hope, Healing and a Life in Transplant）。
致2021年醫學院畢業班：
當我寫這篇公開信時，我想象著一個年輕的自己坐在你們身旁，像你們一樣，不知道接下來會發生什么。
在畢業和開始實習之間的那段焦慮期，我擔心自己的身體和精神狀態是否能勝任行醫：長時間的工作以及智力要求。我學到的是，最重要的挑戰是情感、倫理和哲學，是對精神和靈魂的考驗，而不只是對身體和思維的考驗。
我現在寫這篇公開信是因為我覺得我們正處在美國醫學發展的一個拐點。隨著國家——也希望是全世界——從Covid-19大流行的黑暗中走出來，是時候讓那些從事衛生保健的人來解決某些現實問題了。公開信通常充滿了高談闊論，勸告你們投身于治療藝術，致力于這一崇高的職業。這一切我都贊成，但我真正想說的是更沉重的主題。
說醫療保健從業人員正經歷著一個獨特的時代，這過于輕描淡寫了?；蛟S只有經歷過1917-1918年大流感的我們的前輩才能說他們經歷了類似的事情，那場流感大流行在全世界造成了約5000萬人死亡。在冠狀病毒大流行期間，你們中的許多人被過早地征召上崗，你們還沒有做好準備，但不要為此感到難過。同樣沒有做好準備的還包括我們中那些有幾十年醫療經驗的人，以及我們的衛生保健系統。我們被打了個措手不及，這是你我都無法想象的。
在你們開始實習計劃時，我提供三條經驗和一個請求，希望你們在進入大流行后的醫療世界時能夠牢記。
一。作為經歷了毀滅性的Covid-19大流行的第一屆醫學院畢業班，你們深知你們將要加入的是一支被圍困、但沒有被打敗的醫療隊伍。你們可以幫助這些人重新振作起來。你們將作為第一代醫生，通過你們自己的觀察和經歷，知道如果醫生不能照顧好自己，就無法照顧好他人。你們已經看到了真相，我希望你們能避免許多老醫生沒能避免的事情：對工作、職業、環境的幻滅感。人們稱之為倦怠，這是個糟糕的提法。導致它的通常不是臨床醫生內部的問題，而往往是外部力量：醫院政治、不良的醫療政策、電子病歷，以及看到病人接二連三死去時同情心的耗竭。
但是，即使我們情感上的PPE（個人防護裝備）已被剝離，就像我們的防護服和N95口罩一樣被丟棄，我們仍然面臨一個嚴峻的現實。醫療保健系統對病人不起作用，對臨床醫生當然也不起作用。這一現實對你們這一代醫生來說是一份不受歡迎的畢業禮，如何讓美國的醫療服務重新站穩腳跟，將取決于你們。這將是一個艱巨的任務。美國醫學的先驅們開發了癌癥治療、心臟治療、器官移植，以及最近的冠狀病毒疫苗，他們面臨的困難更多。讓衛生保健體系擺脫陳規，讓聰明的頭腦發揚光大，我們可以創造奇跡。
二。這場疫情讓我們再次看到，資源較少、連接渠道較少、獲得醫療機會較少的個人和社區受到大流行病的影響尤為嚴重。必須承認，其中很多都是那些皮膚比你我更黑的人。對于有色人種來說，這場大流行病不僅僅是困難，簡直是毀滅。失去了健康和生計的有色人種的數量，與我們社會的其他部分是不成比例的。
這些差異并不新鮮，令人驚訝的是許多人是第一次聽到這些差異。但是，從事醫療的人幾十年來一直都知道這些問題，在醫學研究的幾乎每一個方面都有詳細的相關描述。
在這次大流行之后，我們不能再無視這一點了。數據是有說服力的，成績單已經出來了，研究問題的時間已經用盡，現在該是采取行動的時候了。你們是必須領導這項工作的醫生。畢業生們，請務必通過你們在臨床實踐和行政工作中的行動，盡你們所能，解決這種不公正現象。我們需要同一個醫療保健系統——而不是一個給白人，另一個給有色人種。我們這一代人沒有完成這項工作，而你們必須完成。這是正確的事情，去做吧。
三。我們需要把人性放回醫療服務中。美國的醫療保健系統——其實根本就不是一個系統，而是一套支離破碎的利潤中心——已經變得沒有靈魂，是一個不守規矩的龐然大物，既沒有效率，也不公平，更無法管理。這個令人不舒服的事實歸因于許多因素：保險公司支配病人的護理，在診所里過度安排病人，以及一貫將利潤置于目的之上，這也只是其中的幾點。病人需要醫生為他們治療，并提供已知有效的方法。但他們也需要我們傾聽他們的故事，了解他們是誰，而不僅僅是他們得了什么病。我們需要花同樣多的時間來傾聽這些故事，就像我們處理電子病歷一樣。
最后，是我的懇求。寫下你關于工作的故事，包括考驗與磨難，成功與失敗，以及從病人、家人和護理人員那里學到的教訓。在哪里寫都可以：寫在日記里，寫在你的手機或記事本上，甚至寫在一張沾滿咖啡的餐巾紙上。然后告訴你的朋友和家人，如果你有足夠的勇氣，告知公眾。這些故事可以使你這個寫作者受益，作為一種宣泄方式。也能豐富讀者，他們可能是另一位衛生保健工作者、病人、未來的病人，或者醫護人員的家人。寫作的另一個原因是，它們可能有朝一日成為新療法產生的基礎。
但寫作最重要的原因或許是，當我們講述真實的個人在與醫療系統互動時遭受侮辱，當我們揭露差異與不公，當傷害真實個人的醫療差錯在頁面上出現，我們是在為只有故事才能揭示的事件和統計數據加上了人臉，以防止這些不公正現象繼續下去。充滿數據的PPT演示永遠無法成就這一目標。
當你們在擁抱新職業、新生活、新使命時，我把這些留給你們。在之后的旅程中，我們所有人都需要聽到你們的聲音。通過你們的文字、圖片，你們的社交媒體帖子，告訴我們你們的想法和感受。這將有助于保持你們的健康，并因此保持我們其他人的健康。
（老馬譯于2021.06.28）
附原文：
An open letter to 2021 medical school graduates
By David Weill
June 27, 2021
To the medical school graduating class of 2021:
As I write this, I imagine a younger version of myself sitting next to you, not knowing, like you, what will come next.
I worried, during that anxious period between graduation and the start of residency, whether I was up to the physical and mental tasks of being a physician: the long hours and the intellectual requirements of practicing medicine. What I learned was that the most important challenges would be emotional, ethical, and philosophical, tests of the spirit and soul rather than of the body and mind.
I’m writing now because I feel we’ve reached an inflection point in American medicine. As the country — and hopefully the world — emerges from the darkness of the Covid-19 pandemic, it’s time for those in health care to address certain realities. Letters of this sort are usually filled with soaring rhetoric, exhortations to devote yourselves to the healing arts and commit completely to this noble profession. I am in favor of all that but have a more somber message.
To say that health care practitioners are living through a unique time would be the understatement of the century. Perhaps only our ancestors who lived through the 1917-1918 influenza pandemic, which killed an estimated 50 million people around the world, can say they went through something similar. During the coronavirus pandemic, many of you were called into duty prematurely. You weren’t ready. Don’t feel badly though. Neither were those of us who had decades of medical experience. And neither was our health care system. We got caught flat-footed in ways that you and I could have never imagined.
As you begin your residency programs, I offer three lessons I hope you’ll keep in mind as you enter the post-pandemic medical world. And I’ll finish with a plea.
One. As the first graduating medical school class that experienced the full force of the devastating Covid-19 pandemic, know this: You are joining a beleaguered, but not defeated, health care workforce. But you can help reenergize these folks. You will be the first generation of physicians to know, through your own observations and experiences, that doctors can’t take care of other people if they can’t take care of themselves. You have seen what that looks like and I hope you will avoid what so many older doctors didn’t — disillusionment with the job, the profession, the work environment. This phenomenon has been popularly called burnout, though that’s a poor term for it. It isn’t generally caused by some sort of internal problem unique to the clinician, but most often arises due to external forces: hospital politics, bad health care policies, the electronic medical record, and, yes, the depletion of empathy after seeing patients die one after the other.
But even as our emotional PPE has been stripped away, discarded like the paper gowns and N95 masks we use to protect our physical selves, we are left with a stark reality: The health care system doesn’t work for patients and it certainly doesn’t work for clinicians. That reality is an unwelcome graduation gift to your generation of doctors, and it will be up to you to figure out how American health care can regain its footing. It will be a tall order, but the pioneers in American medicine who developed cancer treatments, heart therapies, organ transplantation, and, more recently, coronavirus vaccines, faced tougher odds. We can get miraculous things done when the health care system gets out of their way and lets brilliant minds flourish.
Two. We learned (again) that individuals and communities with fewer resources, fewer connections, and less access to health care were disproportionately affected by the pandemic. It must be acknowledged that many of these individuals had darker skin than mine and, at least statistically, yours. For people of color, the pandemic hasn’t been just tough, but devastating. People of color lost their health and their livelihoods in numbers that were disproportionate to the rest of our society.
These disparities are not new, although surprisingly many in the public are hearing about them for the first time. But people in health care have known about them for decades, well-described in research studies pertaining to nearly every facet of medicine.
After the pandemic, we can no longer deny that, if we ever could. The data is convincing, the report card is in, so the time for studying the problem is over — the time to act is now. You are the physicians who must lead this effort. Graduates, do what you can to address this injustice, through your actions in your clinical practices and in your administrative roles. We need one health care system — not one for white people and another for people of color. My generation can help, but we haven’t gotten the job done. You must. It’s the right thing to do — get to it.
Three. We need to put humanity back in health care. The U.S. health care system — which is really not a system at all, but rather a fragmented set of profit centers — has become soulless, an unruly behemoth that is neither efficient, equitable, or manageable. This uncomfortable truth is attributable to many factors: insurance companies dictating patient care, overscheduled patient encounters in the clinic, and consistent placement of profit over purpose, to name just a few. Patients need their doctors to treat them and provide therapies known to work. But they also need us to hear their stories and understand who they are, not just what diseases they have. We need to spend as much time hearing these stories as we do tending to the electronic medical record.
I said I would make a plea at the end. Here it is: Write down your stories about your work, its trials and tribulations, its successes and failures, and lessons learned from patients and family members and caregivers. Anywhere will do: write them in a journal, on your phone or notepad, even on a coffee-stained napkin. Then tell them — to your friends and family and, if you’re brave enough, to the public. These stories can benefit you, the writer, as a form of catharsis. But they also enrich the reader who may be another health care worker, a patient, a future patient, or a family member of caregiver. Another reason for writing is that they can be the hypothesis-generating foundation for what could someday become new therapies or new ways to use old ones.
But perhaps the most important reason for writing is that when we tell stories about real people who, when interacting with the health care system, suffer indignities, when we reveal disparities, or when medical errors that harm real people come alive on the page, we are putting human faces on events and statistics that only stories can reveal and possibly preventing these injustices from continuing. A data-laden PowerPoint presentation will never accomplish that.
I leave you with this as you embrace your new profession, your new life path, your new mission: All of us need to hear from you on this journey. Tell us what you think and feel through your writing, your pictures, and even through your social media posts. It will help keep you healthy and, as a result, the rest of us healthy.
