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A response to the Medical Industrial Complex

11.19. 2018 Written By: Lyubov Slashcheva 291 Times read

This is a web-exclusive article on the theme “Health care: a biblical and cultural concern.” For more stories on this theme, see the November issue of The Mennonite, available here.

Applicants interviewing for health-professional programs are asked this classic question: “Why do you want to be a—?” Most often, preprofessional health students respond with, “I want to help people,” along with rationale from various meaningful experiences or personal connections to the specific field of health care. They recall playing first aid in their toddler years, cite interactions with family or adult mentors in the field or point to particular encounters during college years. Ultimately, a distinct desire emerges to align one’s vocation with the values and practices of the healing professions.

The journey into health-professional training is rigorous, including meeting coursework requirements, admissions test-score thresholds and engaging in a blend of research and service activities that demonstrate both scientific and humanistic strengths. While admission into a health-professional program may seem like a victory, the next two to four years are often remembered as a struggle to maintain emotional morale and psychological momentum while mastering the art and science of care provision within contexts structured to point out one’s deficiencies. It’s no surprise that medical student depression rates are 15-30 percent higher than that of the general public1. Completion of health professional training is a life milestone that connotes much personal and family pride. But after a weekend of celebration, revealing residency matches or employment offers, and perhaps a vacation or other neglected self-care activity, the demanding reality of working within the healing professions becomes clearer. A provider is equipped with the knowledge base to diagnose and enact treatment, but academic and textbook models of care do not cleanly transfer into a world of productivity quotas, electronic health record policies and insurance or financial barriers to care. The stress of this vocational dissonance alongside life-stage transitions, such as getting married or having children, discourage intentional introspection and emotional health regulation. In the medical profession, a study demonstrated that 23 percent of residency interns had suicidal thoughts.2 Suicide rates for male physicians are 1.41 times higher than the general male population and 2.27 times higher in female physicians.3 A 2018 documentary, “Do No Harm: the Hippocratic Hoax,” sheds light on these alarming realities. Though less thoroughly studied, similar challenges exist in dental, pharmacy, nursing and other health-care professions.

There are many factors that create this unhealthy milieu, but economic and political forces are potent contributors. The concept of the Medical Industrial Complex was first championed by Barbara and John Ehrenreich in 1969 to demonstrate the conflicts of interest that exist between the for-profit health-care industry with its stockholders and the general public, the users of care services.4 Akin to the Military Industrial Complex, public policy is influenced by the economic forces that supply our health-care systems. This results in an equilibrium where industry administrators make decisions, and their stockholders benefit, while health-care professionals and their patients get lost amid the political and economic power struggles.

Another military-derived concept that has made its way into the healing professions is moral injury. Initially used to describe the dissonance and harm soldiers experience during war when they act or fail to act in accordance with their moral beliefs or sense of social responsibility,5 the term is now used to interpret the phenomenon of physician burnout.6  The argument is that provider self-regulation and patient-centered care is not compatible with the current system of health care. Acknowledging this, the Institutes for Health Improvement have proposed that provider well-being is so important that it should be the fourth component added to the ratified roadmap for improving the nation’s health-care system, the Triple Aim—enhancing patient experience, improving population health and reducing cost.7 The movement toward reforming a health-care system that has become violent to those with whom it is most intimately involved is encouraging. But as with the reform of all imperial systems of power, it will likely be slow and resisted by those who have political or economic dominance to lose.

Whether we identify as health-care professionals or patients, what might be our response as Anabaptists? This is the question that has been the missional center for the Mennonite Healthcare Fellowship (MHF) since its inception in 2011: “to be an interdisciplinary community of Anabaptist health professionals that seeks to nurture the integration of faith and practice, provide opportunities for dialogue on health-related issues, and address specific needs through education, advocacy and service.”8 Through the core functions of mutual support, education, mentorship and mobilization for service, MHF honors the legacies of its predecessor organizations while also evolving in responsive ways for the health-care landscape of tomorrow.

In the 1940s, it was uncommon for Mennonites to obtain the higher education needed to work in the healing professions. Young people leaving their communities of origin for education and employment didn’t easily assimilate within the mainstream of their professions. Seeking to establish their own subculture for mutual support, they convened as the Mennonite Medical (MMA) and Mennonite Nurses (MNA) associations. The focus of these groups was integrating faith values into practice. Mandatory military conscription through the early 1970s compelled many Anabaptist health-care professionals to choose 1-W alternative service by teaching in academic institutions, practicing in psychiatric hospitals or pursuing other alternative-service options. This gave way to a missional movement within Anabaptist health-care circles where some served abroad while others established their practices within underserved communities stateside. Through the years, these organizations also have served as a resource to the church on ethical issues in health care.

Dr. Joe Longacher, a recently retired MHF board member and past president of MMA, says that today’s Anabaptist practitioners are similarly service-oriented and utilize their faith-based values to make decisions within their profession that impact both their patients and their colleagues. He also contrasted the experience of today’s practitioner. Vocations are now more specialized for some, society and the church are less unified and there are more demands on time and energy within and outside career. Thus, many are hesitant to engage actively in yet another organization. However, Joe also reaffirmed that MHF is the only organization whose purpose is to provide Anabaptist health-care providers with mutual support and opportunities for service and education.

Dr. Kenton Derstine, another recently retired MHF board member and a past president of the Mennonite Chaplains Association (MCA), expresses an urgent need for the holistic perspective on health that is recognized by MHF’s diverse fellowship of Anabaptist providers. He says that collaboration of a diversity of health-care perspectives is paramount to working together to support optimal health through holistic preventive and therapeutic approaches on both the individual and community level. With the disbanding of MCA in 2017, Kenton urges chaplains to continue engaging with other Anabaptist health-care professionals through MHF.

As I plod through a final year of dental residency and prepare to begin practice in the niches of public health, geriatric and special-needs dentistry, I ask myself why I want to be a dentist. On most days, my answer is optimistic. On other days, it is jaded by a variety of demands and details. I think back to my introduction to MHF five years ago, when I was a second-year dental student. As a first-generation graduate student, I found values gained during undergraduate studies at Eastern Mennonite University, Harrisonburg, Va., most formative for developing a distinct professional identity. Connecting with a diverse fellowship of like-minded health-care providers through MHF became both a source of inspiration and a comfort. Continuing in my role as MHF president this year, I reminded our board of directors to recognize the core of our Anabaptist identity as a peace tradition. Our unique opportunity is to be a peace witness within the healing professions, in seeking to do no harm as individual health-care providers, faith communities and practitioners within our professions. We welcome many more diverse perspectives into this fellowship to reimagine conscientious objection within a Medical Industrial Complex era.

Lyubov Slashcheva is board president of Mennonite Healthcare Fellowship.

 

References:

  1. Morris N. 2016. Medical school can be brutal, and it’s making many of us suicidal. The Washington Post.
  2. Guille C, et al. 2015. Web-based cognitive behavioral therapy interventions for the prevention of suicidal ideation in medical interns. JAMA Psychiatry. 72(12): 1192.
  3. Schernhammer ES, et al. 2004. Suicide rates among physicians: A quantitative and gender assessment (Meta-Analysis). American Journal of Psychiatry AJP. 161(12):2295-2302.
  4. Ehrenreich B and Ehrenreich J. 1969. The Medical Industrial Complex. The Bulletin of the Health Policy Advisory Center. November Issue.
  5. Litz BT, et al. 2009. Moral Injury and moral repair in war veterans: a preliminary model and intervention strategy. Clinical Psychology Review. 29(8):695-706.
  6. Talbot SG and Dean W. 2018. Physicians aren’t ‘burning out.’ They’re suffering from moral injury. STAT. July 26,2018.
  7. Bodenheimer T and Sinsky C. 2014. From Triple to Quadruple Aim: care of the patient requires care of the provider. Annals of Family Medicine. 12(6):573-576.
  8. Mennonite Healthcare Fellowship. About MHF. Mission Statement. Mennohealth.org.

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