As I was preparing for my 30-year reunion from medical school, I nostalgically dug into my aging yearbook and found an inspiring quote that I had included on my profile page. You of course remember Dr. Rudolf Virchow, of the famed Virchow’s node. Remember that left-sided supraclavicular lymph node? Well Virchow was also a physician with a broader view on society. He famously said:
Should medicine ever fulfill its greatest ends, it must enter into the larger political and social life of our time; it must indicate the barriers which obstruct the normal completion of the life-cycle and remove them.
These words have guided my journey as a physician over these past 30 years.
During my fourth year of medical school, I was on rounds with one of my favorite attending physicians, Dr. Zenia Cherynk. She was suggesting we could discharge a now-stable patient after a month-long hospitalization for complications of chronic alcoholism. He had been close to death at points.
I was irked. What would happen to him after he went home? Won’t he just start drinking again? I wondered what measures could we be taking to treat the underlying cause of the metabolic diseases we had been managing? She looked directly at me, her dark eyes leveled at mine. “Well of course,” she said with certainty, “He might be back in here on Monday and we will start all over.”
I was shocked. We had spent so much time — and money! — stabilizing a chronic disease situation, while doing nothing to prevent or address the patient’s alcohol consumption — the primary driver of his disease. My young medical student mind rebelled against this. What kind of system only responds to end-stage disease, rather than pursuing disease prevention and healthy living — with equal vigor?