Changing the World

“…when the visit is over, I have solved one real problem.  Just one, maybe a relatively small one.  But that grateful patient, on that day, leaves armed with concrete information that will improve their health.  I didn’t rewrite history, but I put a ripple in the water. “

I had the audacity in my youth, to believe I could reform the US healthcare system.  I would personally crusade for–and open access to–high quality primary care for every American.  The federally qualified community health center, a model for comprehensive primary care, already existed; it just needed expanded access for all.  The necessary shifts in policy, payments and infrastructure were simple and obvious.  It was unfathomable that any American could not or would not agree on such a basic human need that benefitted individuals and communities both now and generations in the future.

I thought, as a physician, that I would prevail as the voice of authority and reason with policy makers, payers and administrators. Working in the trenches as a rural family doc in Appalachia would lend me experience and credibility.

I could not have been more wrong.

I am now a “mid-career” physician: tired, cranky and always behind on paperwork. I’ve seen so much that–while I haven’t seen it all–rarely does anything still have power to raise my eyebrow. 

From interest and necessity, I have worked hard to understand: clinical medicine, healthcare policy and healthcare administration, the intricacies of Medicaid and Medicare, how drugs are priced, the Affordable Care Act, and risk management, among other topics.

What I have learned after countless phone calls, letters, faxes and meetings, is that our healthcare system is a gigantic balled up wad of Christmas lights no one has the inclination or motivation to detangle.  It is impossible to penetrate, cannot be understood. It is illogical, redundant. Attempts to decipher it lead to a dead end and often a big shock.

I’m a slow learner, so it took time to accept that I failed to reform healthcare because it cannot be done. The realization put me in a brief slump, feeling as if I’d wasted my life hiding in the mountains instead of campaigning for justice for all.  What if I’d tried harder?

I could have chosen differently, spent my career crafting policies impacting entire populations.  But, at the end, did my work matter would still have been the haunting question.  I’m not convinced that my non-career as a policy maker would have gotten me much more than migraines and a retirement pot luck.

Instead, I’m a middle-aged country doc. No one outside my community knows my name.  My patients call me Ma’am, Hon and even Sweetie. I call insurers, pharmacies and specialists in front of my patients so they know I am their advocate. I have no special authority or power, repeating my identifiers and waiting on hold just like everyone else.

But when the visit is over, I have solved one real problem.  Just one, maybe a relatively small one.  But that grateful patient, on that day, leaves armed with concrete information that will improve their health.  I didn’t rewrite history, but I put a ripple in the water.  I find deep satisfaction in knowing that I made a difference for that patient on that day. 

And it is enough. 

Melissa L. Zook, MD, FAAFP, FASAM, HIV-S
Family Practice Physician 
London Women’s Care – London, KY


Dr. Zook will be speaking at the
2022 Head for the Hills Conference
on November 4-5th in Abingdon, VA

Click here for more details on this year’s conference!

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