Southcentral Foundation

When I started my journey in healthcare alongside my fellow science majors, I initially viewed it as a technical exercise, a problem to solve involving diseases that needed to be identified and cured. It seemed like a linear process: encounters with people receiving care, identifying their conditions and then arranging the necessary treatments. How young and naive I was back then.

This perspective was shaped by TV shows that portrayed healthcare providers as detectives, using skills to uncover conditions just in time and save the day. That myth might have been true if we were discussing machines needing intricate repairs, but we were not.

As I progressed through college, I learned what were considered the necessary skills. Medical school applied these more specifically to diseases and disorders. Residency placed them in real-world settings. It all seemed straightforward. Yet once I transitioned to practice, everything changed.

As I conversed with people receiving care and asked about their lives, families and work, I began to see a different perspective. Over time, they shared stories about exciting, frightening or significant events that had shaped them or their loved ones. They also asked about my life and it was rewarding to share my own experiences. I carried out my work as trained: identifying conditions, giving advice on treatments or arranging consultations. Yet amid this, something began to shift.

I realized I was not merely managing diseases or treatments, but people and their desires. Instead of focusing only on a set of symptoms, I was addressing the reasons they came to see me, what they believed was wrong and what they wanted me to do. Sometimes this aligned easily, like confirming high blood pressure, cholesterol or blood sugar. At other times, alignment was less clear.

“I realized I was not merely managing diseases or treatments, but people and their desires. Instead of focusing only on a set of symptoms, I was addressing the reasons they came to see me, what they believed was wrong and what they wanted me to do.”

The more I reflected, the clearer it became. It was not just about diseases or conditions but understanding what they wanted and what I wanted and whether those two matched. If not, perhaps with time and discussion a mutual understanding could develop. I had not been trained for situations where alignment never came.

As years passed, what once frustrated me shifted to curiosity. Why didn’t our desires align? It seemed simple, I only wanted them to receive what they needed based on science. Yet they sometimes sought something entirely different.

I noticed that with patience, conflicting desires sometimes aligned over time. Often, it just required more explanation, reassurance or time. But alignment did not always occur. When it did, those who engaged with me needed my help less. They became more knowledgeable about their condition, asked for support to continue what worked and sometimes even taught me.

I realized those who needed me most were the ones with whom I had not yet established rapport or alignment. Sometimes my own desires needed to adapt; other times, even then, alignment evaded us.

By this point, I had also begun to experience the business side of medicine, the instructions I was given and the reasoning behind them. Most of the time, those rules considered neither my desires nor those of the people receiving care. The focus was on money, billing, compliance or other concerns. I started to realize there were really three sets of desires to manage: what the person wanted, what I wanted and what the business wanted. When these aligned, the work was easier. But when they did not, the question arose: which was most important? Who got to choose or who needed to shift perspectives?

My curiosity deepened. Why did the healthcare industry prioritize these specific desires? Sometimes it was about avoiding risk. At other times, it felt driven more by profit. The industry seemed to cling to a linear model where the practitioner’s role was to identify the disease and treat it. Often this approach prioritized financial gain, then tried to mitigate losses by reducing risk and legal exposure. It seemed less about the genuine desire to do well for people receiving care.

I watched the industry evolve, adding technology and interventions, many drug- or procedure-based, into disease management. Yet none of this addressed underlying desires. What did practitioners and patients truly want? What brought fulfillment? What mattered most?

As I connected more deeply with the individuals I cared for, my curiosity sharpened. Why did the industry overlook their desires when that was what care was supposed to address? When care worked exceptionally well, it was because all three sets of desires aligned. I had witnessed this. Yet over the years, such alignment seemed less likely.

The solution appeared simple: ask those involved in the care process, both providers and patients, what they desired and find ways to align those wishes. Their requests were not unreasonable.

That is when I began questioning who was truly setting the desires for the healthcare industry. In most cases, it was not the people engaged in care. Those in charge had often been trained as practitioners but had transitioned into policy roles and no longer practiced or had not engaged in years. Some had never been trained at all, still stuck in the mindset I once had, that medicine was a TV show where the process was linear and detached from desire. For them, it was about finding diseases and treating them. They never asked whether that was wanted or aligned with my own desires.

I began to see that many of those deciding policy had been trained as practitioners or attorneys but had never practiced either. What they practiced was policy. I wondered what their desires were and what their policies aimed to achieve. Policies themselves do not care, they simply reflect the intentions of those writing them, which often had little to do with patient needs. The policy authors had their own motivations and it seemed many were driven more by creating policies than by improving care.

As I approach the end of my career, it has become clearer that there are two distinct groups: the people and practitioners engaged in healthcare, aligning their desires and the group driving policy. I am uncertain whether their desires can ever be aligned. These groups want very different outcomes. Many in the policy group hold titles suggesting experience as practitioners or attorneys, but in reality they have only practiced policy.

I believe the healthcare group and the policy group either need to part ways or undergo serious reconciliation about what they truly desire. At present, it is the most dysfunctional relationship I have ever witnessed.