When I went to medical school over 30 years ago I dreamed of working in exotic places, plagued with poverty, where nothing was familiar and where I could be of use. It sounded deeply gratifying. I imagined that I might escape the small fiddly problems of my privileged life by trading them for large, worthy problems. I longed for the feeling of being sure that I was doing the right thing. Not long after finishing my residency in internal medicine I took a trip to Thailand where, after being a tourist for several days, I visited a leprosy colony run by the Anglican church near the city of Chiang Mai, spending a week there watching and trying to help out. It was profoundly educational. Not only did I learn about the disease but also about all of the creative approaches the hospital there used to manage anything from chronic wounds to physical disability and patients' need to have meaningful work. The patients had illnesses that took years to heal, and they had workshops where they...
The cost of health care in the US is higher than anywhere else in the world, and yet we are not healthier than our peer nations. In fact, in terms of such measures as infant mortality and life span, we don't measure up. Why is this? Many people involved in providing or receiving care have some pretty good ideas about what costs so much, and what we can do to reduce costs and improve quality. Sharing these stories is an important step in creating affordable universal health care.