What Matters Most to a Physician and Best-Selling Author

Session 350

Dr. Marty Makary is a world-renowned surgeon and author. He joins me to talk about the purpose of medicine, the medical establishment, and how to be consciously disruptive.

For more resources to help you on this journey, check out Meded Media.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[00:26] The Modern Day Hippocratic Oath

Every 50th episode, I recite the Hippocratic Oath written in 1964 by Dr. Louis Lasagna. Hopefully, reading this oath can give you a bit of motivation as you remember why you’re doing this and so you’d have the drive to continue forward.

The Hippocratic Oath is something you decide during the white coat ceremony when you start medical school and you’re given a white coat by the medical school. This is something you should hold near and dear to your heart.

Today, I’m reciting the modern-day version of the Hippocratic Oath.

Hippocratic Oath- Modern Version

“I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”

[04:00] Understanding Today’s Healthcare

Back on today’s episode, Dr. Makary is a chief at the Johns Hopkins Eyelid Transplant Center at Johns Hopkins Hospital. Today, we’re talking about the book he wrote, The Price We Pay: What Broke American Healthcare – and How to Fix It.

This is an amazing discussion on healthcare. You need to understand this for your medical school interview or as a future physician. You don’t have to know everything about this. But at least try to understand it from a superficial level.

'If you're going into healthcare, this is something you should want to know about. It's going to be changing all the time.'Click To Tweet

[06:04] A Little Background About Marty

'Being a physician is still the most respected profession in the world.'Click To Tweet

Marty chose to become a physician because of the level of respect and trust people have over physicians. Initially, he thought of being a missionary doctor. He found a lot of “pontificating” in medicine but there’s something appealing about the surgical field to him. He found the operating room to be a little intimidating yet cool.

In his mind, the harder task in medicine is to listen to people, to diagnose, and to coordinate care while being a surgeon is the easier road.

Marty explains that the reason to write a book is if you believe that there’s a story that needs to be told that nobody else is telling.

[09:45] Understanding Modern Medicine

In medical school, there’s a psychological conditioning that happens. People get to see the good side and bad side. It can be awesome and daunting at the same time. This got Marty interested in the subject of medical errors.

'People could die not just from the disease or illness that brings them to care, but from the care itself.'Click To Tweet

Marty thinks that modern medicine today is missing the boat on so many important things – on food as medicine, meditation, and treating public health issues such as loneliness. Loneliness affects people’s health. We don’t talk about frailty and physiological reserves.

Marty loves the students he works with at the Johns Hopkins Hospital who think about those things. They ask whether they can treat hypertension with yoga as the first line of therapy. Or whether they can treat arthritis with a low inflammatory diet or talk about the microbiome as a reason for abdominal pain. These are things that modern medicine has not been able to process or understand.

Our current system has this construct – since we don’t have any studies on what you’re asking and there’s no evidence, therefore, it’s not true. This is logical reasoning is not correct at all and it’s been very dangerous. This is something we need to challenge.

'Sometimes modern medicine doesn't know what to do with you. And it's that fallacy that there's no study, therefore, there's no evidence, therefore it's not true.'Click To Tweet

[14:30] Medical Conditions Our Society Has Created

Society has created a whole host of conditions and medicine is in a rut where we can’t talk about these root problems because of this kind of logic. Good thing our new generation of students is questioning a lot of the stuff we’re doing.

For instance, the opioid epidemic is a manifestation of the manufactured crisis by the modern medical-industrial complex. It’s one manifestation of the problem of too much medical care or medical errors. We need to disrupt this medical establishment that has told us to get in line and don’t question this.

[18:00] How Students Can Overcome the Challenges in Healthcare

As a student, you want to link up with doctors you feel you have good chemistry with, not only with interpersonal skills but also, philosophical chemistry.

Marty explains they like premeds and medical students watching them in surgery who are hyper communicators. They want those who ask a lot of questions and who are proactive.

When his colleague does interviews, he wants to know if the student could at least talk about a sport as this is a sign of affability.

Additionally, be able to identify mentors. Observe what others do when you’re rotating at a hospital.

'There are many ways to distinguish yourself as a premed student.'Click To Tweet

Think big. Join an effort, cause, or movement. They need less robotic personalities and more people with passion.

For instance, a group of students has started a movement called Restoring Medicine. These are gap year students, undergrads and premed students who are calling things out. They’re part of the generation that believes in social justice that wants to have a sense of purpose in life.

[23:24] How Can Hospitals Run If They Can’t Money From Patients?

Doctors and hospitals need to be paid for their services. But they’re suing low-income patients for bills that they cannot afford.

Most hospitals have a charter at their founding dedicating them to be a safe haven for the sick and injured regardless of one race, ethnicity, or their ability to pay. This is the great American heritage of our profession.

Medicine has always been an open door, equal opportunity caregiver. But a significant percentage of Americans has lost trust in the healthcare system now. There are hospitals that make a lot of money who put liens in people’s homes.

'One-quarter of the American public now doesn't trust us anymore.'Click To Tweet

Marty underlines the fact that physicians went into medicine for a unifying reason which is to help people. But where is that compassion?

Hospitals don’t pay taxes because they’re nonprofit organizations dedicated to serving communities. However, what’s happening now in American medicine is the business of price gouging, surprise bills, egregious markups, unnecessary medical care. It’s a disgrace to the profession.

Moreover, there is a need for students to know about healthcare literacy, not just medical literacy. This is the main reason Marty wrote the book, The Price We Pay. He wants to explain the problems in healthcare medicine and highlight the disruptors who are going to fix it.

'In medical school, we're taught medical literacy, but not healthcare literacy. We're never taught the business of medicine.'Click To Tweet

[28:40] Medicine is Still an Amazing Field

Marty wishes to tell students who are interested in medicine that medicine needs their help.

Medicine is on the brink of having its public trust eroded by these egregious, predatory billing practices, predatory screening practices of overtreatment, and problems ranging from overmedicating to spending 10 minutes with the patient in trying to address complex issues.

Medicine is never intended to be like this. And this is the struggle right now. We need people now to go into medicine and stand up for what’s right. We need people who believe in the mission of medicine in its great medical heritage.

'When you have businesses that can't compete anymore with business overseas because of healthcare, that is the American tragedy.'Click To Tweet

We don’t have money for schools, education, and other important national priorities because of all the taxpayer dollars getting shunted towards healthcare. Marty mentions the movie The Big Short which does a great job explaining the banking crisis.

The banks have told the public for years leading up to the 2008 crisis that banking is very complex so people have to leave it to them. But it wasn’t complex. It was as simple as banks spending money they didn’t have on toxic loans they should have never been giving out.

Meanwhile, the independent rating agencies were being paid to give a rating. Hence, there’s this conflict of interest and they’re giving artificially inflated ratings. The system eventually collapsed. Marty believes this is exactly what’s happening with healthcare right now.

The money games are very fixable. The solution sometimes is embarrassingly simple. We need public transparency of the secret negotiated prices between hospitals and insurance companies.

'There should be no secrecy in healthcare. We should have honest billing practices. Billing quality should be a part of hospital quality.'Click To Tweet

Nevertheless, Marty is positive and sees this as an exciting time. He adds that the best part of his job as a surgeon is his students who come up to him and say something should be done.

Being close to DC, his team gets to go to Congress and even the White House where they can get to talk to policymakers. They tell them about the stories of their patients and how they’re being hammered right now. They plead that these policymakers listen to their stories.

[Related episode: How Do I Know if Medicine Is Right For Me?]

[34:24] Redesigning Healthcare

In his book, Marty highlighted a guy working at a primary care clinic who questioned the practice of seeing patients for 10-12 minutes each patient. So he started a clinic that is now globally capitated. They’re paid in a lump sum so they don’t have to bill. It’s called a relationship clinic.

'Relationship-based primary care medical clinics are taking off in America right now.'Click To Tweet

There are now a bunch of fast-growing primary care clinics around the country. Some of these are 20- to 30-clinic systems. They’re growing like weeds and people love them because they’re spending time with their doctors. The doctors love it because they can spend time getting into the real issues with their patients.

Marty believes we can teach students how to take somebody with severe depression and treat it not with medication, but with community.

Clinics like Iora Health, ChenMed, and Oak Street Health take talented individuals and teach them how to hold a patient’s hand and care for them. Health coaches and navigators go to their homes. They meet at the community center and teach a cooking class. They have a yoga studio.

'We're seeing this tremendous movement now to move medical care out of these big hospital buildings into communities.'Click To Tweet

We’re now basically seeing people who say they can completely redesign medical care from scratch. They can make it better if they’re freed from the bondage of billing, 10-minute patient visits that accounts for a lot of the overtreatment.

Burnout rates in medicine are at record-high levels. That said, Marty would not let this discourage any student from going into the profession. Especially now, because there is a movement to reclaim medical care and to redesign healthcare from scratch.

Marty thinks the cause of burnout is the lack of any followup or the loop being closed where the patient says “thank you” at the end of the process. But emergency room doctors don’t get this.

Patients want care close to them and we’ve got telemedicine. So there are a bunch of exciting, new ways of looking at care.

[41:00] How Students Can Get Involved

Keep your passion. We need passionate students and with deep sense of purpose in going into medicine.

If the idea of practicing medicine all day long sounds daunting, just remember that most people now are planning on some kind of hybrid career. You can be a physician and author. Or a physician and a podcaster.

'We need to message better in medicine as we've lost some of the public.'Click To Tweet

Messaging is very important. If we just keep writing in the medical journals, we’re only talking to ourselves. But when you start writing on the Wall Street Journal or do a podcast, then we get the word out there.

Marty is positive that things are going to get better. The past generation mourns the gold era of medicine. But medicine is still an incredible profession. If you’re a premed student and really want to do this, follow your passion and get involved.

[45:09] Marty’s Books and Final Words of Wisdom

Marty’s first book Unaccountable was turned into a TV series, The Resident on Fox TV. They get set the issues of unaccountability in healthcare.

In an attempt to educate somebody on the business of medicine from A-Z, Marty wrote the book, The Price We Pay. You will learn a lot of things about why healthcare costs so much. He also explains a lot of mythology, legend, and folklore as well as strong opinions that are not substantiated.

Marty outlines two fundamental drivers of our healthcare cost crisis. First is the appropriateness of care. Second is the pricing failures in the marketplace.

In terms of the appropriateness issue, there has been to much care. A concrete example is the opioid crisis. 50,000 to 70,000 people die a year from prescription opioids.

He also explains “the middlemen of healthcare.” Thousands of millionaires who are not patient-facing have been created by the healthcare system. With the $3.5 trillion we spend on healthcare, almost 1$-5$ in the economy are spent on healthcare.

'This is a house of cards and if we don't clean it up, this could be the next great recession. It's a bubble and it can burst.'Click To Tweet

Ultimately, Marty recommends that you find a doctor you get along with. Don’t be afraid to reach out to doctors. Create your own experience. Research about doctors to be mentored by.

If you want to do research, type the doctor’s name in PubMed.org and see if they publish and they’ve written any articles and whether they tend to put students on those papers. This tells you about someone’s research productivity.

Finally, see if you can get the opportunity to talk about the deep, underlying root issues of medicine with these physicians. See their passion and if it matches your passion.

Whatever your passion is, there are ways to screen for it among doctors you talk to. Never underestimate the value of spending time with nurses, nurse practitioners, and physical therapists and EMTs.

Do you know of books about the healthcare system that you like? Tweet me @medicalschoolhq. Let me know what your favorite book is.