The Citadel – Catalyst for Healthcare Change
Recently, Mr. John Walsh, NHS Leeds, wrote an excellent post entitled “Seeds for the Future” inspired by twentieth century physician and author, A. J. Cronin. Dr. Cronin is author of “The Citadel“, a book that facilitated profound healthcare changes in the United Kingdom, and went on to win a National Book Award in the United States. In this post, I reflect on John’s post, and share in his passion for the power of words and ideas to drive meaningful change.
“Our words and what we share can shape the future.” – John Walsh
The Citadel is the story of a young and idealistic physician, Dr. Andrew Manson, who quickly becomes immersed in the dysfunction and injustices of the medical system in which he practices. Over time, the pressures of practicing in this system begin to change his values and his outward character. In the end, it is only through self reflection, after the harsh critique of a longtime physician and friend, that Dr. Manson is able to rediscover meaning and purpose in his profession.
The Citadel is credited, by many, with igniting controversy and an ongoing conversation that ultimately lead to the formation of the National Health Service.
Positive Change for Patients
In the past decade, in the United States, we have witnessed dramatic changes in the organization of our own healthcare system. One positive result is that more patients now have access to healthcare.
Patients also readily have at their disposal new tools which they can use to not only research information about their own illness, but also objectively measure and monitor it. In addition, social media has made it possible for patients to come together, form communities, and provide support for one another in ways never previously imagined.
More and Less Meaningful for Physicians
At the same time, relationships between patients and providers are becoming increasingly strained. Meaningful use requirements in the United States have forced physicians to practice differently.
Physicians now spend more and more of their time entering data into computers. Providers stare into fluorescent screens at hospitals at clinics. In the process, they find, they barely have time to talk their patients, their staff or even one another.
Doctors, who endured the rigorous training in order to have the privilege of serving patients, now find themselves serving data to government, payors, and large institutions.
Physicians, not surprisingly, are increasingly becoming burned out, taking extended periods of away from medicine or simply retiring early. Physician burnout is not just happening in general practice, it’s happening with increasing frequency in my specialty of urology.
Storytelling: Creating Meaningful Change
Cronin’s writings remind us of our responsibility, as physicians, to bring issues that adversely affect our patients, our profession, and ourselves out of the dark and into the light.
Every physician has a story to tell
Each generation of physicians experiences its own unique obstacles, challenges, and frustrations. Every physician has his or her own story to tell.
Modern physicians have an unprecedented number of tools, including Twitter, Facebook, blogs and good old-fashioned pen and paper, with which they can share their stories. What remains to be seen is to what degree my generation of physicians will follow in Dr. Cronin’s footsteps, and to what degree our efforts will result in meaningful change.
I would like to take this opportunity to thank Dr. Glenn Janus who, twenty five years ago, encouraged me to read “The Citadel” while I was an undergraduate at Coe College in Cedar Rapids, Iowa. Though I may not have fully appreciated it at the time, in retrospect, it was very sage advice.
I would like to thank Mr. John Walsh, @johnwalsh88, for suggesting this Transatlantic collaboration. It has been a pleasure to get to know John. I’ve found his writings to be not only inspirational but also motivational.
Finally, a special thank you to Marie Ennis-O’Connor, @JBBC, for introducing me to John, and to Angela, @healthiscool, who first introduced me to blogging and continues to help me find my voice.
What a fascinating perspective! Fiction helps and aids reality? I believe it. I know it to be true. As a high school English teacher, I see that TO KILL A MOCKINGBIRD opens up student perspectives and that LORD OF THE FLIES makes students consider just how a society functions best. I have seen fiction change lives.
There’s a concern, though. While I support many of the targets that COMMON CORE STATE STANDARDS aims to hit, it is reducing fiction by a significant margin. It’s essential to have stories, yet we’re entering an educational world where their value is being reduced.
We must fight to tell and hear stories. It turns out that they can be quite productive–even in the “real world”.
Thank you for the post.
David Theune
Dave,
Thank you for sharing your experience, insights and thoughtful comments.
I believe educators and physicians currently face similar challeges. Our respective occupations are increasingly being evaluated, judged and compenstated on the basis of data.
This will will almost certainly improve certain aspects of both education and medicine. That being said, I’m concerned about the human cost of this approach.
Being a physican, I have a lot of experience with the educational system. The best teachers, I believe, teach us how to find our inner values and how to think critically.
Dr. Glenn Janus, whom I reference in the post, was that kind of professor. He didn’t spoon feed information. Instead, he helped students learn how to identify their inner interests and passions and how to think for themselves. This is why he remains, to this day, one of my favorite professors – along with Dr. Stanley Watkins in the Department of Chemistry at Coe.
Fiction helps us learn from the journeys of others, both real and imagined. Without reading, learing from and retelling these stories I think we lose a part of our shared humanity. Fiction, as John points out in his post, can help serve as a morale compass. In this day and age, I think we could all use a morale compass.
I recently read this timely post about how reading fiction might make us better physicians. I thought you might enjoy it.
https://in-training.org/can-reading-fiction-make-better-doctor-8201
Again, Dave, thank you for your comments.
Brian
Beautifully written Brian. It’s been a personal joy to get to know you over the past year and see the man behind the physician – the doctor who knows how to extend empathy toward those who suffer, and to join honestly and courageously with patients in their illnesses.
Thank you Marie!
I really enjoyed meeting and getting to know you at Stanford Medicine X.
It was you, via Twitter, who introduced me to John. Without the introduction, this Transatlantic collaboration would not have been possible.
The beauty of the post, in my opinion, is in the collaboration.
I have tremendous respect for what you are doing, via social media, on behalf of the patient community.
Brian
Kudos, Brian for a wonderful piece. The narrative is essential in health care, the patient’s story, intersected with the clinician’s story is how we can truly understand the experience. Encouraging sharing of our stories builds relationship and well-being.
Best,
Pam
Pam,
Thank you for reading the post and for your kind comment. I agree, at the end of the day, I believe patients and physicians both want the same thing.
More and more roadblocks are currently being placed between patients and their providers.
While we work together to change the system for the better, we can also work to change ourselves.
Your recent haiku challenge really got me thinking about ways in which I can change myself – hopefully, for the better.
Brian
https://pamressler.blogspot.com/2015/01/month-of-mindfulness30-day-challenge.html
Brian – you write from the heart, obvious in all your blogs, but they are getting stronger and stronger. This really deserves a wide readership, and I’d encourage everyone reading this to amplify it.
Nick
Nick,
Thank you!
I’ve really enjoyed following your posts. You have done a fantastic job with your website. I strongly encourage everyone to check it out.
https://www.nickbrookurology.com
It’s been amazing to watch, almost in real time, the global urology community start to really come together via social media.
It’s been an interesting journey and I’m not exactly sure where it’s all going or where it will eventually end up…
I do know that every generation of physicians leaves their mark, good or bad, on the history of medicine. I appreciate your ongoing friendship and I’m glad we have an opportunity to make our mark together.
Brian
Hi Brian
Thank you for your kind words and letting me know that my mindful Haiku challenge inspired you to make it your own personal challenge…isn’t this what we also hope for our kids, friends, loved ones, and patients? To find meaning and relevance is personal, but having inspiration and company on the journey is how we make it happen. Thanks for keeping me company :-)
Pam
Excellent post Brian! Very thought-provoking
Declan
Hi Brian, your blog is inspirational. I have always used reflection (self and with patients)in my midwifery practice. I have written my stories, how i understand care as publications and often the idea for my papers is the need to share ideas for change to improve patient care.
Or self reflection in my portfolio on good and not so good events in my work life and ways to make things better. Reflection is a great learning tool. Keep up your good work
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Very great post sir! Thank you for sharing.