致2021年醫(yī)學(xué)院畢業(yè)生的一封公開信
大衛(wèi)·威爾（David Weill）
2021年6月27日
作者介紹： 大衛(wèi)·威爾坯屿，1990年畢業(yè)于杜蘭大學(xué)醫(yī)學(xué)院（Tulane University School of Medicine）阔蛉，肺移植領(lǐng)域?qū)＜冶蛤荆栕稍兗瘓F(tuán)（Weill Consulting Group）負(fù)責(zé)人唐片，斯坦福大學(xué)醫(yī)學(xué)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(yī)學(xué)院畢業(yè)班：
當(dāng)我寫這篇公開信時(shí)趁冈，我想象著一個(gè)年輕的自己坐在你們身旁，像你們一樣拜马，不知道接下來會(huì)發(fā)生什么渗勘。
在畢業(yè)和開始實(shí)習(xí)之間的那段焦慮期，我擔(dān)心自己的身體和精神狀態(tài)是否能勝任行醫(yī)：長時(shí)間的工作以及智力要求俩莽。我學(xué)到的是旺坠，最重要的挑戰(zhàn)是情感、倫理和哲學(xué)扮超，是對精神和靈魂的考驗(yàn)价淌，而不只是對身體和思維的考驗(yàn)。
我現(xiàn)在寫這篇公開信是因?yàn)槲矣X得我們正處在美國醫(yī)學(xué)發(fā)展的一個(gè)拐點(diǎn)瞒津。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(shí)候讓那些從事衛(wèi)生保健的人來解決某些現(xiàn)實(shí)問題了括尸。公開信通常充滿了高談闊論巷蚪，勸告你們投身于治療藝術(shù)，致力于這一崇高的職業(yè)濒翻。這一切我都贊成屁柏，但我真正想說的是更沉重的主題。
說醫(yī)療保健從業(yè)人員正經(jīng)歷著一個(gè)獨(dú)特的時(shí)代有送，這過于輕描淡寫了淌喻。或許只有經(jīng)歷過1917-1918年大流感的我們的前輩才能說他們經(jīng)歷了類似的事情雀摘，那場流感大流行在全世界造成了約5000萬人死亡裸删。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阵赠，你們還沒有做好準(zhǔn)備涯塔，但不要為此感到難過。同樣沒有做好準(zhǔn)備的還包括我們中那些有幾十年醫(yī)療經(jīng)驗(yàn)的人清蚀，以及我們的衛(wèi)生保健系統(tǒng)匕荸。我們被打了個(gè)措手不及，這是你我都無法想象的枷邪。
在你們開始實(shí)習(xí)計(jì)劃時(shí)榛搔，我提供三條經(jīng)驗(yàn)和一個(gè)請求，希望你們在進(jìn)入大流行后的醫(yī)療世界時(shí)能夠牢記。
一践惑。作為經(jīng)歷了毀滅性的Covid-19大流行的第一屆醫(yī)學(xué)院畢業(yè)班腹泌，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(yī)療隊(duì)伍童本。你們可以幫助這些人重新振作起來真屯。你們將作為第一代醫(yī)生，通過你們自己的觀察和經(jīng)歷穷娱，知道如果醫(yī)生不能照顧好自己绑蔫，就無法照顧好他人。你們已經(jīng)看到了真相泵额，我希望你們能避免許多老醫(yī)生沒能避免的事情：對工作配深、職業(yè)、環(huán)境的幻滅感嫁盲。人們稱之為倦怠篓叶，這是個(gè)糟糕的提法。導(dǎo)致它的通常不是臨床醫(yī)生內(nèi)部的問題羞秤，而往往是外部力量：醫(yī)院政治缸托、不良的醫(yī)療政策、電子病歷瘾蛋，以及看到病人接二連三死去時(shí)同情心的耗竭俐镐。
但是，即使我們情感上的PPE（個(gè)人防護(hù)裝備）已被剝離哺哼，就像我們的防護(hù)服和N95口罩一樣被丟棄佩抹，我們?nèi)匀幻媾R一個(gè)嚴(yán)峻的現(xiàn)實(shí)。醫(yī)療保健系統(tǒng)對病人不起作用取董，對臨床醫(yī)生當(dāng)然也不起作用棍苹。這一現(xiàn)實(shí)對你們這一代醫(yī)生來說是一份不受歡迎的畢業(yè)禮，如何讓美國的醫(yī)療服務(wù)重新站穩(wěn)腳跟茵汰，將取決于你們枢里。這將是一個(gè)艱巨的任務(wù)。美國醫(yī)學(xué)的先驅(qū)們開發(fā)了癌癥治療经窖、心臟治療坡垫、器官移植，以及最近的冠狀病毒疫苗画侣，他們面臨的困難更多冰悠。讓衛(wèi)生保健體系擺脫陳規(guī)，讓聰明的頭腦發(fā)揚(yáng)光大配乱，我們可以創(chuàng)造奇跡溉卓。
二皮迟。這場疫情讓我們再次看到，資源較少桑寨、連接渠道較少伏尼、獲得醫(yī)療機(jī)會(huì)較少的個(gè)人和社區(qū)受到大流行病的影響尤為嚴(yán)重。必須承認(rèn)尉尾，其中很多都是那些皮膚比你我更黑的人爆阶。對于有色人種來說，這場大流行病不僅僅是困難沙咏，簡直是毀滅辨图。失去了健康和生計(jì)的有色人種的數(shù)量，與我們社會(huì)的其他部分是不成比例的肢藐。
這些差異并不新鮮故河，令人驚訝的是許多人是第一次聽到這些差異。但是吆豹，從事醫(yī)療的人幾十年來一直都知道這些問題鱼的，在醫(yī)學(xué)研究的幾乎每一個(gè)方面都有詳細(xì)的相關(guān)描述。
在這次大流行之后痘煤，我們不能再無視這一點(diǎn)了凑阶。數(shù)據(jù)是有說服力的，成績單已經(jīng)出來了衷快，研究問題的時(shí)間已經(jīng)用盡晌砾，現(xiàn)在該是采取行動(dòng)的時(shí)候了。你們是必須領(lǐng)導(dǎo)這項(xiàng)工作的醫(yī)生烦磁。畢業(yè)生們，請務(wù)必通過你們在臨床實(shí)踐和行政工作中的行動(dòng)哼勇，盡你們所能都伪，解決這種不公正現(xiàn)象。我們需要同一個(gè)醫(yī)療保健系統(tǒng)——而不是一個(gè)給白人积担，另一個(gè)給有色人種陨晶。我們這一代人沒有完成這項(xiàng)工作，而你們必須完成帝璧。這是正確的事情先誉，去做吧。
三的烁。我們需要把人性放回醫(yī)療服務(wù)中褐耳。美國的醫(yī)療保健系統(tǒng)——其實(shí)根本就不是一個(gè)系統(tǒng)，而是一套支離破碎的利潤中心——已經(jīng)變得沒有靈魂渴庆，是一個(gè)不守規(guī)矩的龐然大物铃芦，既沒有效率雅镊，也不公平，更無法管理刃滓。這個(gè)令人不舒服的事實(shí)歸因于許多因素：保險(xiǎn)公司支配病人的護(hù)理仁烹，在診所里過度安排病人，以及一貫將利潤置于目的之上咧虎，這也只是其中的幾點(diǎn)卓缰。病人需要醫(yī)生為他們治療，并提供已知有效的方法砰诵。但他們也需要我們傾聽他們的故事征唬，了解他們是誰，而不僅僅是他們得了什么病胧砰。我們需要花同樣多的時(shí)間來傾聽這些故事鳍鸵，就像我們處理電子病歷一樣。
最后尉间，是我的懇求偿乖。寫下你關(guān)于工作的故事，包括考驗(yàn)與磨難哲嘲，成功與失敗贪薪，以及從病人、家人和護(hù)理人員那里學(xué)到的教訓(xùn)眠副。在哪里寫都可以：寫在日記里画切，寫在你的手機(jī)或記事本上，甚至寫在一張沾滿咖啡的餐巾紙上囱怕。然后告訴你的朋友和家人霍弹，如果你有足夠的勇氣，告知公眾娃弓。這些故事可以使你這個(gè)寫作者受益典格，作為一種宣泄方式。也能豐富讀者台丛，他們可能是另一位衛(wèi)生保健工作者耍缴、病人、未來的病人挽霉，或者醫(yī)護(hù)人員的家人防嗡。寫作的另一個(gè)原因是，它們可能有朝一日成為新療法產(chǎn)生的基礎(chǔ)侠坎。
但寫作最重要的原因或許是蚁趁，當(dāng)我們講述真實(shí)的個(gè)人在與醫(yī)療系統(tǒng)互動(dòng)時(shí)遭受侮辱，當(dāng)我們揭露差異與不公实胸，當(dāng)傷害真實(shí)個(gè)人的醫(yī)療差錯(cuò)在頁面上出現(xiàn)荣德，我們是在為只有故事才能揭示的事件和統(tǒng)計(jì)數(shù)據(jù)加上了人臉闷煤，以防止這些不公正現(xiàn)象繼續(xù)下去。充滿數(shù)據(jù)的PPT演示永遠(yuǎn)無法成就這一目標(biāo)涮瞻。
當(dāng)你們在擁抱新職業(yè)鲤拿、新生活、新使命時(shí)署咽，我把這些留給你們近顷。在之后的旅程中，我們所有人都需要聽到你們的聲音宁否。通過你們的文字窒升、圖片，你們的社交媒體帖子慕匠，告訴我們你們的想法和感受饱须。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台谊。
（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.
