Elizabeth V. Looney, MD
Family Medicine Resident, Class of 2019
MetroHealth Medical Center, Case Western Reserve
Cleveland, Ohio
Pisacano Scholar, Class of 2015

The opinions and views expressed here are those of the author and do not necessarily represent or reflect the opinions of the Starfield Summit or its funders. This blog is not intended to provide medical, financial, or legal advice.

In medicine, we are both victims and perpetuators of tribalism. From the moment we firstdeclare the desire to pursue a career in medicine, we are faced a stemming question: "Yes . . but what kind of doctor do you want to be?" Instantly conflated with an identity in medicine itself is a pressure to define that identity based on what we will not be doing. We grow from undifferentiated, pluripotent physician-hopefuls into specialized, distinctive tribes, oftentimes before we realize what is happening to us. The question then becomes: In this house so divided, how do we stand together as a healthcare team to address the global issues affecting us all -- namely, a higher functioning healthcare system?

One of the answers which emerged from the discussion on Teams was that the de-tribalization of the medicine must start early on. Currently, as we "grow up" in medicine, we do so along a linear trajectory that floats further and further away from other specialties. We start early on to distance ourselves from the issues that seem to plague only other specialties, and become invested or divested accordingly. Why does this matter for those of us interested in reform? Because somewhere along the way, the bettering of our healthcare system has become a primary care issue alone. Our tribal mentality, then, is a major stumbling block to reform; each facet of medicine needs to pull their weight in order for us to be successful, because the system we are working in represents all of us. Undergraduate medical education and residency need to entail intentional training and teaching on the working together of medical disciplines to share not just a common vision for our patients, but for our entire healthcare system. From the moment our professional identities hatch, a shared responsibility for the future of healthcare should start to grow as well.

A further point that emerged from this discussion was that we need to not only reach out and embrace our specialty colleagues, but each and every member of the healthcare team. From our receptionists and MAs to the CEOs and administrators of our hospitals, we must first believe -- and then act on the belief -- that everyone has something to contribute. The work of creating a higher performing, more just healthcare system is simply not possible to accomplish without the support, camaraderie and expertise of each and every member of the healthcare community -- including our patients! Multiple examples were cited on the micro- and macro-levels of higher-functioning organizations that resulted from intentional involvement of every player with a stake in the game, not just the traditional leaders. The Patient-Centered Medical Home (PCMH) is one well-known example of this model, along with numerous original ideas that Summit attendees had witnessed in their own healthcare settings.

So where does this leave us as primary care physicians? Looking at the Starfield Summit as a revamping of our game plan, our job is to be the initial leaders and galvanizers of the global reform team. Whatever level we are involved at -- from undergraduate medical education onwards, there are things we can do. From the Teams discussion, I offer two key points in sum:

* We need to change the culture of medicine so that our very identities, rather than basedon distinction from one another, include early on a deeply held and shared, pragmatic commitment to making our healthcare system better.

* We must believe that everyone in healthcare, in both the horizontal and vertical directions, has something to offer towards the reform movement. Once we are convinced of this notion, we must actively seek to involve representatives from as many of these sectors as possible. In doing so, not only do we cultivate buy-in and solidarity, but our approach is that much more likely to without critical blind spots and ultimately, effective.