致2021年医学院毕业生的一封公开信
大卫·威尔（David Weill）
2021年6月27日
作者介绍： 大卫·威尔，1990年毕业于杜兰大学医学院（Tulane University School of Medicine），肺移植领域专家，威尔咨询集团（Weill Consulting Group）负责人，斯坦福大学医学中心高级肺病中心前主任。2021年5月出版回忆录《呼气：希望、治愈和移植中的生活》（Exhale: Hope, Healing and a Life in Transplant）。
致2021年医学院毕业班：
当我写这篇公开信时，我想象着一个年轻的自己坐在你们身旁，像你们一样，不知道接下来会发生什么。
在毕业和开始实习之间的那段焦虑期，我担心自己的身体和精神状态是否能胜任行医：长时间的工作以及智力要求。我学到的是，最重要的挑战是情感、伦理和哲学，是对精神和灵魂的考验，而不只是对身体和思维的考验。
我现在写这篇公开信是因为我觉得我们正处在美国医学发展的一个拐点。随着国家——也希望是全世界——从Covid-19大流行的黑暗中走出来，是时候让那些从事卫生保健的人来解决某些现实问题了。公开信通常充满了高谈阔论，劝告你们投身于治疗艺术，致力于这一崇高的职业。这一切我都赞成，但我真正想说的是更沉重的主题。
说医疗保健从业人员正经历着一个独特的时代，这过于轻描淡写了。或许只有经历过1917-1918年大流感的我们的前辈才能说他们经历了类似的事情，那场流感大流行在全世界造成了约5000万人死亡。在冠状病毒大流行期间，你们中的许多人被过早地征召上岗，你们还没有做好准备，但不要为此感到难过。同样没有做好准备的还包括我们中那些有几十年医疗经验的人，以及我们的卫生保健系统。我们被打了个措手不及，这是你我都无法想象的。
在你们开始实习计划时，我提供三条经验和一个请求，希望你们在进入大流行后的医疗世界时能够牢记。
一。作为经历了毁灭性的Covid-19大流行的第一届医学院毕业班，你们深知你们将要加入的是一支被围困、但没有被打败的医疗队伍。你们可以帮助这些人重新振作起来。你们将作为第一代医生，通过你们自己的观察和经历，知道如果医生不能照顾好自己，就无法照顾好他人。你们已经看到了真相，我希望你们能避免许多老医生没能避免的事情：对工作、职业、环境的幻灭感。人们称之为倦怠，这是个糟糕的提法。导致它的通常不是临床医生内部的问题，而往往是外部力量：医院政治、不良的医疗政策、电子病历，以及看到病人接二连三死去时同情心的耗竭。
但是，即使我们情感上的PPE（个人防护装备）已被剥离，就像我们的防护服和N95口罩一样被丢弃，我们仍然面临一个严峻的现实。医疗保健系统对病人不起作用，对临床医生当然也不起作用。这一现实对你们这一代医生来说是一份不受欢迎的毕业礼，如何让美国的医疗服务重新站稳脚跟，将取决于你们。这将是一个艰巨的任务。美国医学的先驱们开发了癌症治疗、心脏治疗、器官移植，以及最近的冠状病毒疫苗，他们面临的困难更多。让卫生保健体系摆脱陈规，让聪明的头脑发扬光大，我们可以创造奇迹。
二。这场疫情让我们再次看到，资源较少、连接渠道较少、获得医疗机会较少的个人和社区受到大流行病的影响尤为严重。必须承认，其中很多都是那些皮肤比你我更黑的人。对于有色人种来说，这场大流行病不仅仅是困难，简直是毁灭。失去了健康和生计的有色人种的数量，与我们社会的其他部分是不成比例的。
这些差异并不新鲜，令人惊讶的是许多人是第一次听到这些差异。但是，从事医疗的人几十年来一直都知道这些问题，在医学研究的几乎每一个方面都有详细的相关描述。
在这次大流行之后，我们不能再无视这一点了。数据是有说服力的，成绩单已经出来了，研究问题的时间已经用尽，现在该是采取行动的时候了。你们是必须领导这项工作的医生。毕业生们，请务必通过你们在临床实践和行政工作中的行动，尽你们所能，解决这种不公正现象。我们需要同一个医疗保健系统——而不是一个给白人，另一个给有色人种。我们这一代人没有完成这项工作，而你们必须完成。这是正确的事情，去做吧。
三。我们需要把人性放回医疗服务中。美国的医疗保健系统——其实根本就不是一个系统，而是一套支离破碎的利润中心——已经变得没有灵魂，是一个不守规矩的庞然大物，既没有效率，也不公平，更无法管理。这个令人不舒服的事实归因于许多因素：保险公司支配病人的护理，在诊所里过度安排病人，以及一贯将利润置于目的之上，这也只是其中的几点。病人需要医生为他们治疗，并提供已知有效的方法。但他们也需要我们倾听他们的故事，了解他们是谁，而不仅仅是他们得了什么病。我们需要花同样多的时间来倾听这些故事，就像我们处理电子病历一样。
最后，是我的恳求。写下你关于工作的故事，包括考验与磨难，成功与失败，以及从病人、家人和护理人员那里学到的教训。在哪里写都可以：写在日记里，写在你的手机或记事本上，甚至写在一张沾满咖啡的餐巾纸上。然后告诉你的朋友和家人，如果你有足够的勇气，告知公众。这些故事可以使你这个写作者受益，作为一种宣泄方式。也能丰富读者，他们可能是另一位卫生保健工作者、病人、未来的病人，或者医护人员的家人。写作的另一个原因是，它们可能有朝一日成为新疗法产生的基础。
但写作最重要的原因或许是，当我们讲述真实的个人在与医疗系统互动时遭受侮辱，当我们揭露差异与不公，当伤害真实个人的医疗差错在页面上出现，我们是在为只有故事才能揭示的事件和统计数据加上了人脸，以防止这些不公正现象继续下去。充满数据的PPT演示永远无法成就这一目标。
当你们在拥抱新职业、新生活、新使命时，我把这些留给你们。在之后的旅程中，我们所有人都需要听到你们的声音。通过你们的文字、图片，你们的社交媒体帖子，告诉我们你们的想法和感受。这将有助于保持你们的健康，并因此保持我们其他人的健康。
（老马译于2021.06.28）
附原文：
An open letter to 2021 medical school graduates
By David Weill
June 27, 2021
To the medical school graduating class of 2021:
As I write this, I imagine a younger version of myself sitting next to you, not knowing, like you, what will come next.
I worried, during that anxious period between graduation and the start of residency, whether I was up to the physical and mental tasks of being a physician: the long hours and the intellectual requirements of practicing medicine. What I learned was that the most important challenges would be emotional, ethical, and philosophical, tests of the spirit and soul rather than of the body and mind.
I’m writing now because I feel we’ve reached an inflection point in American medicine. As the country — and hopefully the world — emerges from the darkness of the Covid-19 pandemic, it’s time for those in health care to address certain realities. Letters of this sort are usually filled with soaring rhetoric, exhortations to devote yourselves to the healing arts and commit completely to this noble profession. I am in favor of all that but have a more somber message.
To say that health care practitioners are living through a unique time would be the understatement of the century. Perhaps only our ancestors who lived through the 1917-1918 influenza pandemic, which killed an estimated 50 million people around the world, can say they went through something similar. During the coronavirus pandemic, many of you were called into duty prematurely. You weren’t ready. Don’t feel badly though. Neither were those of us who had decades of medical experience. And neither was our health care system. We got caught flat-footed in ways that you and I could have never imagined.
As you begin your residency programs, I offer three lessons I hope you’ll keep in mind as you enter the post-pandemic medical world. And I’ll finish with a plea.
One. As the first graduating medical school class that experienced the full force of the devastating Covid-19 pandemic, know this: You are joining a beleaguered, but not defeated, health care workforce. But you can help reenergize these folks. You will be the first generation of physicians to know, through your own observations and experiences, that doctors can’t take care of other people if they can’t take care of themselves. You have seen what that looks like and I hope you will avoid what so many older doctors didn’t — disillusionment with the job, the profession, the work environment. This phenomenon has been popularly called burnout, though that’s a poor term for it. It isn’t generally caused by some sort of internal problem unique to the clinician, but most often arises due to external forces: hospital politics, bad health care policies, the electronic medical record, and, yes, the depletion of empathy after seeing patients die one after the other.
But even as our emotional PPE has been stripped away, discarded like the paper gowns and N95 masks we use to protect our physical selves, we are left with a stark reality: The health care system doesn’t work for patients and it certainly doesn’t work for clinicians. That reality is an unwelcome graduation gift to your generation of doctors, and it will be up to you to figure out how American health care can regain its footing. It will be a tall order, but the pioneers in American medicine who developed cancer treatments, heart therapies, organ transplantation, and, more recently, coronavirus vaccines, faced tougher odds. We can get miraculous things done when the health care system gets out of their way and lets brilliant minds flourish.
Two. We learned (again) that individuals and communities with fewer resources, fewer connections, and less access to health care were disproportionately affected by the pandemic. It must be acknowledged that many of these individuals had darker skin than mine and, at least statistically, yours. For people of color, the pandemic hasn’t been just tough, but devastating. People of color lost their health and their livelihoods in numbers that were disproportionate to the rest of our society.
These disparities are not new, although surprisingly many in the public are hearing about them for the first time. But people in health care have known about them for decades, well-described in research studies pertaining to nearly every facet of medicine.
After the pandemic, we can no longer deny that, if we ever could. The data is convincing, the report card is in, so the time for studying the problem is over — the time to act is now. You are the physicians who must lead this effort. Graduates, do what you can to address this injustice, through your actions in your clinical practices and in your administrative roles. We need one health care system — not one for white people and another for people of color. My generation can help, but we haven’t gotten the job done. You must. It’s the right thing to do — get to it.
Three. We need to put humanity back in health care. The U.S. health care system — which is really not a system at all, but rather a fragmented set of profit centers — has become soulless, an unruly behemoth that is neither efficient, equitable, or manageable. This uncomfortable truth is attributable to many factors: insurance companies dictating patient care, overscheduled patient encounters in the clinic, and consistent placement of profit over purpose, to name just a few. Patients need their doctors to treat them and provide therapies known to work. But they also need us to hear their stories and understand who they are, not just what diseases they have. We need to spend as much time hearing these stories as we do tending to the electronic medical record.
I said I would make a plea at the end. Here it is: Write down your stories about your work, its trials and tribulations, its successes and failures, and lessons learned from patients and family members and caregivers. Anywhere will do: write them in a journal, on your phone or notepad, even on a coffee-stained napkin. Then tell them — to your friends and family and, if you’re brave enough, to the public. These stories can benefit you, the writer, as a form of catharsis. But they also enrich the reader who may be another health care worker, a patient, a future patient, or a family member of caregiver. Another reason for writing is that they can be the hypothesis-generating foundation for what could someday become new therapies or new ways to use old ones.
But perhaps the most important reason for writing is that when we tell stories about real people who, when interacting with the health care system, suffer indignities, when we reveal disparities, or when medical errors that harm real people come alive on the page, we are putting human faces on events and statistics that only stories can reveal and possibly preventing these injustices from continuing. A data-laden PowerPoint presentation will never accomplish that.
I leave you with this as you embrace your new profession, your new life path, your new mission: All of us need to hear from you on this journey. Tell us what you think and feel through your writing, your pictures, and even through your social media posts. It will help keep you healthy and, as a result, the rest of us healthy.
