There are physicians who can write—Atul Gawande is Exhibit A—but they are uncommon. Rishi Manchanda is one of them, if “Wide-Angle Healing” in the Winter 2014 issue of Tufts Medicine is any indication. Manchanda’s piece is a cogent, well-wrought explication of all that’s wrong with emphasizing medical care in US health-care thinking.
The physician-author, who is founder and president of HealthBegins, a new health care company in Los Angeles, opens with an effective narrative from his personal clinical experience:
It was an unseasonably warm spring day in south-central Los Angeles in 2011. Veronica, a 33-year-old woman, sat in my exam room, her head in her hands. Her otherwise tall and formidable figure was slouched over in pain. This was not the first time she had felt this way. For more than a year her headaches had come and gone. And each time, the pain would ripple through her life, disrupting her family and work. This episode was no different. She had missed about seven days of work as an office manager at an auto parts dealer in the past month.
Good start. Manchanda uses Veronica’s case as an example of someone who had received treatment that he describes as “what is generally considered adequate care.” Adequate even though Veronica continued to have debilitating headaches. It was only after his clinic noted that her apartment was afflicted with leaks, mold, and roaches, that he could correctly diagnose her problem as a reaction to what she (and her children) had been breathing in the apartment and finally deliver an effective intervention to make her well.
I noted Manchanda’s cogency:
The nature-vs.-nurture debate can no longer be viewed as a battle between equals. The impact of nurture—in the form of the social and environmental settings that surround us—is far more powerful than we’ve ever imagined These are the forces that shape or distort our genes, our behaviors and the landscape of opportunity in our communities.
These essays in alumni magazines frequently suffer from being mealy mouthed; authors shy from asserting anything that might provoke. Manchanda writes like he means it:
I would suggest that the current standard of care itself is simply unacceptable, from a moral and an economic perspective.
That would have been a stronger statement without the “I would suggest” bit, but it still stands out from the vanilla banality that permeates so many university magazines. Good work.