What I do most and what I do best is medicine. Healthcare. So I began to write (this blog was created in 2009) as I saw the compassionate practice of medicine being threatened by a system that has perverse incentives, causing it to be crazily expensive and ever more inadequate.
There was a great deal of debate surrounding equitable payment for medical care leading up to passage of the affordable care act. Much of the debate was uninformed, so I wrote things, from the point of view of a real doctor working with real patients in a variety of pretty normal places. I added some data to the roiling pot of data that is the internet. Threw virtual messages in bottles into the virtual ocean. There are 353 posts, around 2700 visits per month, a few more than 624,000 views over the life of the blog. Maybe some of those views influenced people in ways that made medicine more compassionate, more nuanced, equitable, effective and less ignorant, expensive and daft.
My husband has been working on climate change with an organization called Citizen's Climate Lobby. It is a volunteer organization that pushes for legislation to enact a fee on carbon pollution. He has been actively worried about the effects of greenhouse gases on global climate for decades, but has been involved in this organization for only a few years. It is a good organization doing good work. I have been in my own medical bubble until it just recently popped due to reading Ministry for the Future by Kim Stanley Robinson and experiencing the 2021 western heat wave. In late June and early July we were trapped inside our stifling houses due to unprecedented temperatures that were followed by wildfires, due most likely to climate change. Ministry is a work of fiction that reads like a near future history book, detailing how the human race manages, by hard work and creativity, to barely survive the global increase in temperature that is definitely going to take place. It is optimistic, because it is not necessarily true that the human race will pull together to do what is necessary to save what we love and value, but also motivating. It woke me up to the fact that we are in an "all hands on deck" situation.
But it was just a novel.
Then came the heat wave. I work with people who are poor, who live in trailers or houses without air conditioning, or who have so little money that running an air conditioner even if they have one is too expensive. They live in parts of town where there is no shade. They are dependent on equipment to move around, like wheelchairs or walkers, making it hard to get to a cooler place. They use oxygen which requires electricity to function and there were blackouts. Some are drug addicted and homeless. Some of them died. All of them suffered. It was horrible. It was horrible for them, but also for me. I was grateful I worked in a place with reliable air conditioning and that my car had air conditioning that actually worked. Even with that, it felt like the planet where we live was no longer friendly to humans.
Since that heat wave, I have seen ripple effects. Crops failed. Trees appear to be dying. There are a shocking number of dead deer in the woods. Looking back, last summer wasn't a fluke, it's a trend.
Healthcare is still really interesting. I find certain trends to be heartening--there is more telemedicine increasing access to care, there is more focus on treating drug addiction because of the epidemic of overdose death. Other trends are disturbing--politicization of health decisions, hostility to healthcare workers. Lots to write about. But what really gets under my skin right now is a larger system that is malfunctioning and a more pressing set of problems that need action right now. The impact of climate change on peoples' health is going to dwarf anything I might be able to do to improve medical care.
This blog will still be primarily about healthcare, best to be consistent. But I will also be writing about other things on https://doctorjanicesblog.org. I initially got that URL because it is really hard to be directed to whyisamericanhealthcaresoexpensive. But it is also a comfortable home for other writing. So there you go. The reader is welcome at either location to read and participate.
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