they told me that i'm a traitorto my own profession, that i should be fired, have my medical license taken away, that i should go back to my own country. my email got hacked.
in a discussion forum for other doctors, someone took creditfor "twitter-bombing" my account. now, i didn't know if thiswas a good or bad thing, but then came the response:
"too bad it wasn't a real bomb." i never thought that i would do something that would provoke this level of angeramong other doctors. becoming a doctor was my dream. i grew up in china, and my earliest memoriesare of being rushed to the hospital because i had such bad asthmathat i was there nearly every week. i had this one doctor, dr. sam,who always took care of me. she was about the same age as my mother.
she had this wild, curly hair, and she always worethese bright yellow flowery dresses. she was one of those doctors who, if you fell and you broke your arm, she would ask you why you weren't laughing because it's your humerus. get it? see, you'd groan, but she'd always make you feel betterafter having seen her. well, we all have that childhood hero
that we want to grow upto be just like, right? well, i wanted to be just like dr. sam. when i was eight,my parents and i moved to the u.s., and ours becamethe typical immigrant narrative. my parents cleaned hotel roomsand washed dishes and pumped gas so that i could pursue my dream. well, eventually i learned enough english, and my parents were so happy the day that i got into medical schooland took my oath of healing and service.
but then one day, everything changed. my mother called me to tell methat she wasn't feeling well, she had a cough that wouldn't go away,she was short of breath and tired. well, i knew that my mother was someonewho never complained about anything. for her to tell methat something was the matter, i knew something had to be really wrong. and it was: we found out that she hadstage iv breast cancer, cancer that by then had spreadto her lungs, her bones, and her brain.
my mother was brave,though, and she had hope. she went through surgery and radiation, and was on her third round of chemotherapy when she lost her address book. she tried to look up her oncologist'sphone number on the internet and she found it,but she found something else too. on several websites, he was listed as a highly paidspeaker to a drug company, and in fact often spoke on behalf
of the same chemo regimenthat he had prescribed her. she called me in a panic, and i didn't know what to believe. maybe this was the rightchemo regimen for her, but maybe it wasn't. it made her scared and it made her doubt. when it comes to medicine, having that trust is a must, and when that trust is gone,then all that's left is fear.
there's another side to this fear. as a medical student, i was taking careof this 19-year-old who was biking back to his dorm when he got struck and hit, run over by an suv. he had seven broken ribs, shattered hip bones, and he was bleeding insidehis belly and inside his brain. now, imagine being his parents
who flew in from seattle,2,000 miles away, to find their son in a coma. i mean, you'd want to find outwhat's going on with him, right? they asked to attend our bedside rounds where we discussedhis condition and his plan, which i thought was a reasonable request, and also would give usa chance to show them how much we were tryingand how much we cared. the head doctor, though, said no.
he gave all kinds of reasons. maybe they'll get in the nurse's way. maybe they'll stop studentsfrom asking questions. he even said, "what if they see mistakes and sue us?" what i saw behind every excusewas deep fear, and what i learnedwas that to become a doctor, we have to put on our white coats, put up a wall, and hide behind it.
there's a hidden epidemic in medicine. of course, patients are scaredwhen they come to the doctor. imagine you wake upwith this terrible bellyache, you go to the hospital, you're lying in this strange place,you're on this hospital gurney, you're wearing this flimsy gown, strangers are comingto poke and prod at you. you don't know what's going to happen. you don't even know if you're going to getthe blanket you asked for 30 minutes ago.
but it's not just patients who are scared; doctors are scared too. we're scared of patientsfinding out who we are and what medicine is all about. and so what do we do? we put on our white coatsand we hide behind them. of course, the more we hide, the more people want to knowwhat it is that we're hiding. the more fear then spiralsinto mistrust and poor medical care.
we don't just have a fear of sickness, we have a sickness of fear. can we bridge this disconnect between what patients needand what doctors do? can we overcome the sickness of fear? let me ask you differently: if hiding isn't the answer,what if we did the opposite? what if doctors were to becometotally transparent with their patients? last fall, i conducteda research study to find out
what it is that people wantto know about their healthcare. i didn't just want to studypatients in a hospital, but everyday people. so my two medical students,suhavi tucker and laura johns, literally took their researchto the streets. they went to banks,coffee shops, senior centers, chinese restaurants and train stations. what did they find? well, when we asked people,
"what do you want to knowabout your healthcare?" people responded with what they wantto know about their doctors, because people understand health care to be the individual interactionbetween them and their doctors. when we asked, "what do youwant to know about your doctors?" people gave three different answers. some want to knowthat their doctor is competent and certified to practice medicine. some want to be surethat their doctor is unbiased
and is making decisionsbased on evidence and science, not on who pays them. surprisingly to us, many people want to knowsomething else about their doctors. jonathan, a 28-year-old law student, says he wants to find someonewho is comfortable with lgbtq patients and specializes in lgbt health. serena, a 32-year-old accountant, says that it's important to herfor her doctor to share her values
when it comes to reproductive choiceand women's rights. frank, a 59-year-oldhardware store owner, doesn't even like going to the doctor and wants to find someonewho believes in prevention first, but who is comfortablewith alternative treatments. one after another,our respondents told us that that doctor-patient relationshipis a deeply intimate one — that to show their doctors their bodies and tell them their deepest secrets,
they want to first understandtheir doctor's values. just because doctorshave to see every patient doesn't mean that patientshave to see every doctor. people want to knowabout their doctors first so that they can make an informed choice. as a result of this, i formed a campaign, who's my doctor? that calls for totaltransparency in medicine. participating doctors voluntarily disclose
on a public website not just informationabout where we went to medical school and what specialty we're in, but also our conflicts of interest. we go beyondthe government in the sunshine act about drug company affiliations, and we talk about how we're paid. incentives matter. if you go to your doctorbecause of back pain,
you might want to know he's getting paid5,000 dollars to perform spine surgery versus 25 dollars to refer youto see a physical therapist, or if he's getting paid the same thingno matter what he recommends. then, we go one step further. we add our valueswhen it comes to women's health, lgbt health, alternative medicine, preventive health,and end-of-life decisions. we pledge to our patientsthat we are here to serve you, so you have a right to know who we are.
we believe that transparencycan be the cure for fear. i thought some doctors would sign onand others wouldn't, but i had no idea of the huge backlashthat would ensue. within one week of startingwho's my doctor? medscape's public forum and several online doctors' communities had thousands of posts about this topic. here are a few. from a gastroenterologist in portland:
"i devoted 12 years of my lifeto being a slave. i have loans and mortgages. i depend on lunches fromdrug companies to serve patients." well, times may be hard for everyone, but try telling your patient making 35,000 dollars a yearto serve a family of four that you need the free lunch. from an orthopedic surgeon in charlotte: "i find it an invasion of my privacyto disclose where my income comes from.
my patients don't disclosetheir incomes to me." but your patients' sources of incomedon't affect your health. from a psychiatrist in new york city: "pretty soon we will have to disclosewhether we prefer cats to dogs, what model of car we drive, and what toilet paper we use." well, how you feelabout toyotas or cottonelle won't affect your patients' health, but your viewson a woman's right to choose
and preventive medicineand end-of-life decisions just might. and my favorite,from a kansas city cardiologist: "more government-mandated stuff? dr. wen needs to moveback to her own country." well, two pieces of good news. first of all, this is meant to bevoluntary and not mandatory, and second of all, i'm americanand i'm already here. (laughter) (applause) within a month, my employerswere getting calls
asking for me to be fired. i received mailat my undisclosed home address with threats to contactthe medical board to sanction me. my friends and family urged meto quit this campaign. after the bomb threat, i was done. but then i heard from patients. over social media, a tweetchat, which i'd learned what that was by then, generated 4.3 million impressions,
and thousands of people wroteto encourage me to continue. they wrote with things like, "if doctors are doing somethingthey're that ashamed of, they shouldn't be doing it." "elected officials have to disclosecampaign contributions. lawyers have to discloseconflicts of interests. why shouldn't doctors?" and finally, many people wrote and said, "let us patients decide
what's importantwhen we're choosing a doctor." in our initial trial, over 300 doctors have takenthe total transparency pledge. what a crazy new idea, right? but actually, this is notthat new of a concept at all. remember dr. sam, my doctor in china, with the goofy jokes and the wild hair? well, she was my doctor, but she was also our neighbor
who lived in the buildingacross the street. i went to the same school as her daughter. my parents and i trusted her because we knew who she wasand what she stood for, and she had no need to hide from us. just one generation ago,this was the norm in the u.s. as well. you knew that your family doctorwas the father of two teenage boys, that he quit smoking a few years ago, that he says he's a regular churchgoer,
but you see him twice a year:once at easter and once when his mother-in-lawcomes to town. you knew what he was about, and he had no need to hide from you. but the sickness of fear has taken over, and patients suffer the consequences. i know this firsthand. my mother foughther cancer for eight years. she was a planner,
and she thought a lotabout how she wanted to live and how she wanted to die. not only did she sign advance directives, she wrote a 12-page documentabout how she had suffered enough, how it was time for her to go. one day, when i was a resident physician, i got a call to say that she wasin the intensive care unit. by the time i got there,she was about to be intubated and put on a breathing machine.
"but this is not what she wants,"i said, "and we have documents." the icu doctor looked at me in the eye, pointed at my then 16-year-oldsister, and said, "do you remember when you were that age? how would you have liked to grow upwithout your mother?" her oncologist was there too, and said, "this is your mother. can you really face yourselffor the rest of your life if you don't do everything for her?"
i knew my mother so well. i understood whather directives meant so well, but i was a physician. that was the single hardestdecision i ever made, to let her die in peace, and i carry those wordsof those doctors with me every single day. we can bridge the disconnect between what doctors doand what patients need.
we can get there,because we've been there before, and we know that transparencygets us to that trust. research has shown usthat openness also helps doctors, that having open medical records, being willing to talkabout medical errors, will increase patient trust, improve health outcomes, and reduce malpractice. that openness, that trust,
is only going to be more important as we move from the infectiousto the behavioral model of disease. bacteria may not care so muchabout trust and intimacy, but for people to tacklethe hard lifestyle choices, to address issues like smoking cessation, blood-pressure managementand diabetes control, well, that requires us to establish trust. here's what other transparentdoctors have said. brandon combs, an internist in denver:
"this has brought mecloser to my patients. the type of relationship i've developed — that's why i entered medicine." aaron stupple, an internist in denver: "i tell my patientsthat i am totally open with them. i don't hide anything from them. this is me. now tell me about you. we're in this together." may nguyen, a family physician in houston:
"my colleagues are astoundedby what i'm doing. they ask me how i could be so brave. i said, i'm not being brave, it's my job." i leave you today with a final thought. being totally transparent is scary. you feel naked, exposed and vulnerable, but that vulnerability, that humility, it can be an extraordinary benefitto the practice of medicine.
when doctors are willingto step off our pedestals, take off our white coats, and show our patients who we areand what medicine is all about, that's when we beginto overcome the sickness of fear. that's when we establish trust. that's when we changethe paradigm of medicine from one of secrecy and hiding
Diabetes America Plano,to one that is fully open and engaged for our patients.
thank you. (applause)
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