Against the grain

There was a session at the Jaipur Literature Festival that I found surprisingly close to home in the health care world.  It was titled “Against the Grain” and was summarized as follows:

Voices of individual courage and conviction examine strategies of steadfast truth telling in the face of social pressure and mass opinion.

The panelists comprised a Who’s Who of writers who have taken a stand and engaged in acts of conscience in their work.

Swapan Dasgupta, an Indian conservative columnist, says he is labeled as “contrary because I betray my class, “ a group that has “a self-image of being progressive” but are actually condescending towards those with other views.

“I have lost a lot of friends” by taking positions, he notes. He bemoans this result.  “I don’t think political positions should be viewed as so polarizing as to preclude normal social relationships.”  He proclaimed, “Can’t we let this closed mind attitude disappear?”

Salima Hashmi’s father was jailed in Pakistan for his political views decades ago. This episode and the isolation from her previous friends and neighbors provided lessons for her:  “You learn about value, friendships, and loyalty in these situations.”

These memories, along with her own work, prompted her to elaborate on the themes mentioned by Dasgupta.  “People accept self-censorship.  They accept dictatorial behavior.”  Such attitudes become socialized as the norm.

And then, Gideon Levy, an Israeli whose very life has been threatened because of his views about his country’s occupation of Palestinian territory, went further.  He described many of his countrymen as being in “a pathological denial.  No one wants to know.  No one wants to say.”  They are “ignorant, blind, apathetic, without any moral doubts.”

He went on to explain the role of the journalist: “We are there to give a message that is not convenient.”

I don’t put myself in the category of these great writers.  But I have to say that I have found similar patterns of behavior from many in the health care field when I have raised concerns about the actions of doctors and hospitals that tread on medical ethics, that fail to address ongoing problems of quality and safety in patient care, or that employ overly greedy approaches to corporate acquisitions, mergers, and management.  Several other writers I know have faced the same patterns.

In short, instead of arguing the merits of those issues we raise, those who disagree often adopt the kind of unsocial behavior noted by Dasgupta.  Some simply do not respond, favoring a passive aggressive approach.  Some respond by personal attacks.  Sadly, in the words of Levy, they often present symptoms of being “ignorant, blind, apathetic, without any moral doubts.”

Imagine another world.  Imagine one in which, when challenged about an issue, health care people would listen modestly and carefully, engage in civil discourse, and try their best to think of what approach would best serve their communities—as opposed to what would best serve their individual or corporate interests.

I believe that health care folks can get away with bad social behavior because many media outlets and journalists fear being put in the outcast role described by the JLF panelists.  It is a problem for the public good when journalists accept the unstated and do not probe behind the scenes and expose the inefficiencies, the harm, and the injustices that are endemic to our health care system.  The media simply become outlets for the press releases and pablum produced by vested interests in the field. Were it not for people like Charles Ornstein and his colleagues at Pro Publica, John Fauber at the Milwaukee Sentinel Journel, Elisabeth Rosenthal at the New York Times, many of the major issues facing US health care would receive no attention at all.

I wish my health care journalist colleagues could have been present for this session in Jaipur.  Maybe they would have been stimulated to take on Gideon Levy’s advice: “We are there to shake.”