I met up with a friend last night for some happy hour appetizers at a nice local Mexican restaurant in Williamsburg.  Since we last saw each other in May, he’s traveled to Kenya, attended a family wedding in New England, and twice visited his family in their new home in Georgia.  I, on the other hand, have stayed with family in Minnesota for more than a month, attended a lavish wedding in Santa Barbara, California, and become deeply involved with an internship with the Tuke Institute.  My friend and I had so much to catch up on over cheap margaritas and guacamole.  After we escaped the crowds of hungry hipsters, I was able to finally see his midtown apartment for the first time as we chatted for a couple hours about what we’ve been doing and what our future plans are.

As our conversation shifted to things like food insecurity, the perpetual turmoil that plagues most of the continent of Africa, the rapid urbanization of China and Nigeria, and other such topics white New Yorkers talk about in their high-rent, high-rise apartments, I began to tell him a little bit about the HIV standards we are developing at the Tuke. I explained how Rupert (Whitaker) and I came up with a list of things that people with HIV need, regardless of their location, socio-economic position, race, gender, etc.  I told my friend how when I first started populating the list, I stuck to the safe and familiar–the list that includes mental health services, physical health, and a collaborative team of providers. When I spoke with Rupert, however, he urged me to think outside of that box–to consider that people with HIV want and deserve things like happiness, fun and safety. My friend laughed at that notion and exclaimed, “well everyone wants those things!” as if it was a ludicrous notion to pursue. I retorted that that was the whole point…that people with HIV deserve things like happiness and confidence and freedom from stigma…just like any other person in any part of the world in any situation. Happiness and safety will look quite different in Accra and Santa Barbara and Minneapolis and rural China, but those are the intangible things that all humans should have access to. Those semi-abstract needs are the things that make us human and connected and give us meaning. Without those things, we live fearful, hopeless, and isolated lives.

But the conversation left me feeling worried about these new standards we are setting. If my close friend in my public health program laughs at these ideas, what will my instructor and other classmates say? What will physicians and others clinicians think of these standards? What about policymakers and public health officials? Are these things even worth talking about and addressing when the world’s problems are so big and unmanageable? If we’re trying to address HIV guidelines, are we thinking too far outside the realm of possibility by addressing these issues?

Then this morning I woke up to a New York Times article that my best friend sent me. It was written by one of the children of the mutli-billionaire businessman and philanthropist, Warren Buffett. Although the article was a provocative critical analysis of “the charitable-industrial complex,” it really spoke to me and addressed something very important to my internship.  Peter Buffett eloquently states that:

“It’s time for a new operating system. Not a 2.0 or a 3.0, but something built from the ground up. New code.

What we have is a crisis of imagination. Albert Einstein said that you cannot solve a problem with the same mind-set that created it. Foundation dollars should be the best “risk capital” out there….

Money should be spent trying out concepts that shatter current structures and systems that have turned much of the world into one vast market….

It’s an old story; we really need a new one.”

These thoughtful and challenging quotes truly inspired me and gave me the “hope lift” I needed to continue pushing through the mire of stale thought and poor health standards I have quickly learned comprise the majority of health research and guidelines. I was ecstatic to hear someone speak to the necessity of pushing the boundaries and recreating the way we approach the world’s toughest challenges. Peter Buffett urged me to stop reinventing the square wheel and to start over. If we don’t start from scratch, we make the same unimaginative mistakes and continue contributing to the mess we’ve already made of things. Mr. Buffett reignited in me a flame that was fading. He restored my passion for and faith in what I’m doing and refreshed my memory as to why our work is essential to health and humanity.

07 Jan 2011 09:45

Nick Clegg has announced that he is to introduce real changes into England’s libel laws—a long overdue move in the effort to shuck vested interests out of their protective shells and make English society a more equal and open place (http://bit.ly/eeOp5n). Currently, it takes a very brave person to speak up and risk a libel suit—and there are very few of us who can afford that. Yet it’s very important for the public to be able to speak up and say when a particular individual is not doing their job—especially when that job is in public services and paid for by the public.

It may be a good step towards making the English public, at least, far less timid about speaking up and telling it as they see it. I don’t care for unnecessary confrontation, but coming back to Britain after so many years in the USA showed me that people here are afraid to speak up. Criticism is indirect, ‘diplomatic’, or avoidant and all too often ineffectual. Little changes until people are pushed to unnecessary extremes to be heard and then we get shouting in the clinics—whereupon the complainant is ejected and everything continues badly as before. It is simply oppressive. Whistleblowing is punished, even when it is killing people—we only need to look back at the Bristol Inquiry and the current Stafford Inquiry to see that.

A while ago, I mooted the idea of a well-structured, scientifically based review-website to assess the quality of clinicians’ performance in helping people get well during treatment for an illness. It would show how health-effective a clinician’s practice is and it is more accurate and proactive than simply making a body-count of the dead as we do now. This idea effectively was shut down because I was told “we can’t say that Dr. X has been ineffectual publicly, because it will cause a libel suit”—and this is when Dr. X has been paid by public taxes to provide a service to the public in order to help the public get well from illness. This reality is one of the reasons why clinicians have been untouchable and have had no greater motivation than their own integrity to do a good job. When a clinician has integrity—and we know many who have—she does her best to make sure she is doing a good job; but I also know many clinicians who really can’t be bothered, who see themselves as the victims of a difficult system and weep all the way to the bank as they cash their annual salary of £150,000. Furthermore, what is a good job to a surgeon can be quite different from what it is to a patient: “the surgery was successful but the patient died”. The patient might have reviewed the adequacy of the surgeon’s performance as other than ‘successful’ if he’d lived.

If the NHS or any medical system is to become patient-centred, it has to mean making medical services about helping people become well long-term. How each clinician does that needs to be reviewed publicly. But it’s not a case of using the ludicrous 5-star system of recent times or the current fad for measuring ‘patient satisfaction’; it needs to be a thorough system that looks at all the variables that go into helping people get well. I’ve researched this for a number of years and it’s a complex, scientific issue. It can be done and the public has an essential role in such a review. We need to be able to say it publicly when things are less than adequate, without fear of a lawsuit for libel. Nick Clegg’s initiative is a very, very welcome step in the right direction. Let’s hope he succeeds.