A Vocation with Perks
I do a number of corporate and non-profit films every year. If I had to pick one thing I enjoy most about those projects, it’s the fact I get to meet some remarkable people in the process. Bright, talented, and passionate, the folks I talk with draw me into their worlds and help me see life from new vantage points.
Life is richer for meeting all of them, but every now and then someone I interview really makes an impression.
Last fall I had the opportunity to meet Dr. Diane E. Meier, one of the foremost pioneers in the field of palliative care. She’d been awarded the American Cancer Society Medal of Honor in the area of Cancer Control. I was asked to interview her and take photographs (shared throughout this post) for a piece that would play at her award ceremony.
I’m keenly aware that it’s off top-topic to discuss palliative care—or medicine in general—on a blog nominally dedicated to filmmaking pursuits. Consider this my upfront apology. But I feel what Diane has to say about medicine is important enough to be shared anywhere. Eventually we will all face these kinds of issues, guaranteed. Besides, Dr. Meier has a treasure trove of great stories, and I have a distinct weakness for those.
I think you’ll find her stories resonate with you, too. The more I talked with her last October, the more inspired I felt by her passion, insight, and dedication. She’s smart, perceptive, compassionate… and fiercely present. What I hope to do (as much as possible) is give you the opportunity to experience Dr. Meier in her own words, just as I did.
This is a lengthy interview, and I’ve broken it into four segments to make things a bit easier to read. Part 1 focuses on Diane’s early life and career, and how she became interested in what would eventually be known as the field of palliative care. Part 2 focuses on why this area of medicine makes sense for everyone touched by health care in this country. In part 3, Dr. Meier shares several profound patient stories that helped to shape her knowledge and understanding. The series concluded in part four, with a fascinating discussion of a recent study with surprising results related to the impact of patient-centered care.
Here’s how our conversation started back in October 2012…
Q. What was your life like growing up?
There was always this atmosphere around the house of questioning… talking about why things are the way they are and what would be needed to change them, and that’s kind of the air I breathed as I was growing up in Chicago.
I went to public school through grade 5, then went to the University of Chicago Lab School… studied theatre and writing—things that had nothing to do with what I’m doing now.
Q. What do you remember most vividly about that time?
By the time I finished high school I was pretty sure I wanted to work with older people in some capacity or another because I was very attached to my grandparents—particularly my father’s father—who I had a very close relationship with my whole childhood. He taught me the lesson that people are fundamentally human—all people—and what’s alike about them is much more powerful than what’s different about them.
There was a very strong kind of social conscience, political conscience in my relationship with my grandfather as well as in my home growing up… this sort of notion of humanism and service and a sense of commitment to one’s fellow man.
Q. Are you doing now what you always expected to do with your life?
No. I certainly had no intention of going to medical school at an early age… I was actually pursuing certification as a teacher as an undergrad. But ultimately I decided that I wanted to do something where there was more power to do good; and at the time, I thought medicine was a quicker path to doing good than being a teacher was.
Half-way through her junior year as an undergraduate at Oberlin College, Diane changed course academically and began taking pre-med courses. She went on to graduate from Northwestern Medical School.
Q. How did you get into palliative care issues, and what drew you to that field over other areas of medicine?
I’m a lumper, not a splitter. So for me it was cognitively difficult to think about focusing on one organ or one disease without thinking about the human being, the person—and every other aspect of them—that was influenced by that disease and that, in turn, influenced the disease.
For me it didn’t make sense to write someone a stack of prescriptions without knowing if they could afford them or had the cognitive ability to organize a pill box… It was too narrow of a perspective. So in 1981 I chose to specialize in geriatric medicine, because it was a comprehensive, holistic approach to the patient. Everything was relevant in thinking about how to help the health of an older person.
In 1982 Dr. Meier helped start the first free-standing department of geriatrics in the country at Mt. Sinai, and she joined the faculty there a year later. It was while teaching and conducting research there that she encountered a growing sense of unease about how medicine was being practiced in the U.S.
Q. So by the mid-1980s you were struggling with your direction in medicine?
Yes. I was becoming more and more concerned about the sub-specialization & fragmentation of medicine and my sense that the patient and the family were getting lost in the rapidly evolving technology – diagnostic and therapeutic– and the fact that every body part, every organ system, every disease had a different specialist.
Eventually, I started wondering if there was something wrong with me, that I found this situation so disconnected from the real needs of patients and families. And I actually had some moments where I thought of leaving medicine altogether. Because the disconnect between my perception of what patients and families needed and what was actually happening was really uncomfortable for me. And I didn’t know where to go with it. So I attributed it to my own ‘lack of fit’ with medicine.
Q. What changed for you? What kept you from leaving medicine?
Well, right at that time several private sector funding opportunities aimed at creating true social change in medicine became available. And this large consortium of private funders, including George Soros and the Robert Wood Johnson Foundation, has led to a really stunning change in the US health care system in the last 10 to 12 years… And because of that opportunity, my career took a 180˚ turn to palliative care, even though it was Nowhere-ville in 1999.
Q. Why was it considered Nowhere-ville?
There was a lot of negativity from colleagues—almost contempt—for focusing on what was really happening with these patients and on their quality of life. Eventually, these colleagues realized we weren’t about taking patients away from them but were working along side of them. I think some of it had to do with the way we were all trained, which is that your job as a physician is to pull out every stop possible to prolong life for as long as possible. Death is always, therefore, unexpected… and always a failure. And that’s not an exaggeration, that’s how we were trained… it was almost like a religious fundamental.
So the training really needs to change in order to change the medical culture. Because social change is not a turnkey thing…
If you think about it in evolutionary terms, what we’ve seen in the last 12 years has been incredibly rapid. So within one physician generation there’s been a shift from ‘our goal is to defeat death at any and all costs’ to maybe, ‘our goal is broader than that.’
But that hubris that is often associated with American medicine hasn’t modified itself to a place where we recognize that our role is and should be about serving the person who is our patient, finding out what matters to them, what their major goals and priorities are, doing more listening than talking, and arraying all the resources and tools and wonderful capabilities of the health care system in service of the person’s goals, as opposed to the health care system’s.
We’ve come a long way from the person being genuinely at the center of what we do.
Q. So what should the goal of health care be?
I’ll quote Francis Peabody from a very famous lecture he gave at Harvard in 1925: “The secret of the care of the patient is in caring for the patient.”
We doctors have been caught up in a system that is a business, and like any business has to keep the doors open, and meet payroll and satisfy shareholders…
The way the health care system is organized is based on how it is paid. If you were starting from scratch, and you were creating a new society—you would not create a medical system like this one.
In part two of this interview, Dr. Meier discusses the role creativity plays in science and how she’s been successful in spreading the word about the need for palliative care teams in the U.S. She also shares an important patient story that helped change the direction of her career.