In the din of polemics and punditry about health care reform, we have not heard much from one vitally important voice: that of young people now attending medical school, to whom we will entrust the future of health care.
And that's an oversight because spending some time with medical students was one of the most reassuring stops on my recent documentary-making odyssey for the Humankind public radio health series, "The Search for Well-Being". It's airing this winter and can also be heard online.
Students who get into medical school are often regarded as academia's cream of the crop. And those I met are bright enough to realize that our health system is ailing in ways that go beyond the remedies prescribed by the Affordable Care Act (ACA), which took effect New Year's Day.
Medical education itself has been part of the problem, at least historically. That's changing somewhat -- although slowly -- to accommodate growing awareness of a stark fact: More than three-fourths of U.S. medical costs are attributed to largely-preventable illnesses, according to the Centers for Disease Control and Prevention (CDC).
For those pondering New Year's resolutions, this means what we eat, our level of exercise, how we manage stress and if we smoke.
But medical school traditionally has not trained doctors very well in helping patients think through lifestyle choices. Even in a society rife with diet-related illness -- from heart disease to diabetes to widespread obesity -- nutrition education remains curiously marginalized in medical school.
Amazingly, only about a fourth of medical schools even have a full course on nutrition. And residency programs, where young doctors actually learn how to practice, require no nutrition training in specialties where this could make a huge difference, including internal medicine, cardiology and pediatrics.
At Ohio State University in Columbus, America's third largest college campus, a student had the bright idea to start an elective class in cooking for medical students, now led by a gifted local chef. This has the double-virtue of showing nutrition in context and equipping future doctors with real-life skills that will help them guide patients who struggle with eating well.
And it's a challenge facing those attending medical school themselves. A student leader in the class, Andy Melaragno, told me:
"It's true that a lot of us med students, when the going gets tough, and even when the going is easy, are just stopping over to the Wendy's in the basement of the hospital for our meals, you know. So anything that can help us more easily cook nutritious meals, and fun meals I think would be worthwhile."
Medical students are also concerned about the hurried pace of doctor-patient visits in today's health care environment. A few years ago, some HMOs began limiting physicians to an average visit of seven minutes, as a cost-saving measure.
One medical student at OSU, Louise Kane, told me she had read through transcripts of dialogues between doctors and patients and was appalled by one conversation in which a patient was crying, but the doctor seemed too rushed for a meaningful human connection.
"I told myself I would never be that physician," Kane said.
Added Suman Gupta, another student I interviewed, "This drive towards efficiency is completely money-driven" because it costs less when doctors spend fewer minutes with a patient.
The problem is that hurried encounters with patients make it nearly impossible to counsel people with the subtlety required for lifestyle changes. One ray of light in this health care tunnel is the emerging interest in a team approach to medical treatment.
Starting this month, a large cohort of patients is newly entering the health system -- as people who were previously excluded from coverage are now granted access by the ACA. And many people who had been kept out of doctors' offices bring with them aggravated health conditions, so time pressures on doctors are likely to increase.
To the extent a team approach is embraced, it will mean a larger role for nursing, which many health reformers say is overdue. Nurse practitioners are highly trained (many have a doctorate) and studies show they are superbly qualified to handle most tasks traditionally reserved for primary care docs.
Another very promising development is the rise of health coaches, whose services in some cases will be covered by the ACA. Coaches cost a lot less than doctors and have the time and training to talk with patients in-depth. This means they may be able to really help people with lifestyle behaviors, which famously resist quick-fix solutions -- as anyone who's wrestled with a diet or exercise routine can attest.
One theme I heard over and over from the future doctors is the need for a much deeper approach to disease prevention, not just management of illness once someone gets sick. And that has to start with health care professionals themselves.
"It really raises a red flag to me," said medical student Gupta, "hearing the statistics of how physicians have one of the highest suicide rates, are among the highest drug abusers, are really prone to alcoholism. All these things are sort of red flags, if we're supposed to be the ambassadors of health."
But medical professionals are just part of the health care equation, said Gupta. "Where the second part of the picture comes in is: Our patients aren't expecting to come to the doctor and be told, 'Oh, you need to change your diet. You need to exercise more.' They're expecting some kind of medication, most of the time."
So the question is whether patients are upholding their end of the provider-patient relationship, not just popping pills. As University of Minnesota nursing professor Mary Jo Kreitzer told me in our documentary, "Eighty percent of how healthy people are has nothing to do with doctors, hospitals, drugs. This is a huge mental shift ... to really step back and say, 'I'm responsible.'"